Cristina López-Tinoco

Adipokines and metabolic syndrome risk factors in women with previous gestational diabetes mellitus

Gestational diabetes mellitus (GDM) has been recognized as a significant risk factor for metabolic syndrome and CVD. The aim of the study was to evaluate the relationships between levels of cytokines, components of metabolic syndrome and cardiovascular risk markers in women with previous gestational diabetes.

Parámetros analíticos en el paciente con diabetes mellitus

Actualmente existen numerosas pruebas de laboratorio para el diagnostico y el seguimiento de los pacientes con diabetes mellitus:determinacion de glucemia en ayunas y posprandial, autoanalisis de glucemia capilar, presencia de cuerpos cetonicos, hemoglobina glucosilada y fructosamina, microalbuminuria y determinacion de marcadores geneticos y de autoinmunidad. La evidencia cientifica que respalda cada una de ellas varia sustancialmente y las guias de practica clinica proporcionan las recomendaciones con mayor soporte cientifico junto con otras basadas tan solo en consensos de expertos. En este trabajo se revisan las determinaciones de laboratorio mas importantes en diabetes mellitus y se evalua su grado de evidencia cientifica.

Unfavorable cytokine and adhesion molecule profiles during and after pregnancy, in women with gestational diabetes mellitus

espanolAntecedentes La diabetes mellitus gestacional es un factor de riesgo importante para el sindrome metabolico y la enfermedad cardiovascular. Objetivos Se evaluaron las relaciones entre los componentes del sindrome metabolico, los niveles de citocinas y moleculas de adhesion en mujeres con diabetes gestacional durante el embarazo y en el posparto. Pacientes y metodos Estudio prospectivo de casos y controles. Se analizaron 126 mujeres gestantes (63 con diabetes mellitus gestacional y 63 controles). En el periodo posparto, se reevaluaron 41 casos y 21 controles. Se analizaron variables clinicas, niveles de citocinas y moleculas de adhesion durante las semanas 24-29 de la gestacion y 12 meses despues del parto. Resultados En el periodo posparto, el factor de necrosis tumoral alfa en casos y controles, y la adiponectina en controles fueron significativamente mas altos. Los casos mostraron mayores niveles de leptina, sin diferencias significativas durante el embarazo y despues del parto. No se observaron diferencias significativas en las moleculas de adhesion y la interleucina 6 entre casos y controles durante el periodo de embarazo y el posparto, pero ambos fueron mayores en los casos. Durante el embarazo y posparto, la adiponectina disminuyo en los casos y aumento en los controles. Observamos correlaciones positivas significativas entre adiponectina con glucemia en ayunas y moleculas de adhesion celular vascular-1, y entre leptina y factor de necrosis tumoral alfa. Conclusiones Los resultados indican que el aumento de la inflamacion y la hiperglucemia transitoria durante el embarazo representarian una forma latente de sindrome metabolico, con un mayor riesgo de diabetes mellitus tipo 2 y de enfermedad cardiovascular en el futuro. EnglishBackground Gestational diabetes mellitus is a significant risk factor for metabolic syndrome and cardiovascular disease. Aims To assess the relationships between components of the metabolic syndrome and cytokine and adhesion molecule levels in women with GDM during pregnancy and after delivery. Patients and methods A prospective case–control study on a sample of 126 pregnant women (63 with and 63 without gestational diabetes mellitus). In an intra-subject analysis, 41 women with history of gestational diabetes mellitus and 21 controls were re-assessed in the postpartum period. Clinical data and levels of cytokines and adhesion molecules were recorded during weeks 24–29 of pregnancy and 12 months after delivery. Results In the postpartum period, there were significantly higher levels of tumor necrosis factor alpha in both cases and controls, and of adiponectin in controls. Cases showed higher leptin levels, with no significant differences during and after pregnancy. No significant differences were seen in adhesion molecules and interleukin-6 between cases and controls during pregnancy and in the postpartum period, but levels of both were higher in cases. During pregnancy and after delivery, adiponectin decreased in cases and increased in controls. Significant positive correlations were seen between adiponectin and fasting blood glucose levels and vascular cell adhesion molecule-1, and also between leptin and tumor necrosis factor alpha levels. Conclusions The results suggest that increased inflammation and transient hyperglycemia during pregnancy would represent a latent form of metabolic syndrome, with an increased risk for type 2 diabetes mellitus and future cardiovascular disease.

The Influence of Lipid and Proinflammatory Status on Maternal Uterine Blood Flow in Women With Late Onset Gestational Diabetes

Background: Gestational diabetes mellitus (GDM) is associated with increased proinflammatory cytokines and is also associated with adverse cardiovascular disease (CVD) outcomes later in life. We aim to evaluate the relationships between uterine arteries vascularization and endothelial dysfunction markers, proinflammatory cytokines, and glycemic and lipid profile in women with GDM. Methods: Fifty pregnant women were recruited at the third trimester of pregnancy for a prospective cohort study. They were classified into 2 groups: control and GDM. Comparisons of maternal plasma concentrations of endothelial dysfunction markers (vascular cell adhesion molecule 1, intercellular adhesion molecule 1, and plasminogen activator inhibitor 1), proinflammatory cytokines and mediators (interleukin 6 [IL-6], tumor necrosis factor α, vascular endothelial growth factor, placental growth factor, leptin, leukocyte count, and C-reactive protein), lipid profile, glucose, and glycosylated hemoglobin levels were performed. Mean uterine arteries Doppler pulsatility index (PI) was calculated and the relationships between the variables and PI were also analyzed. Results: Women with GDM showed higher proinflammatory cytokines, however, endothelial dysfunction markers were similar in both groups. In the diabetic group, significant correlations were found between the mean uterine arteries PI and maternal IL-6 (r = .56, P = .01), triglycerides (r = .49; P = .03), total cholesterol/high-density lipoprotein cholesterol (HDL-c) ratio (r = .61; P = .006), glucose (r = .62, P = .005), and glycosylated hemoglobin (r = .48; P = .03). A negative significant correlation between mean uterine arteries PI and HDLc (r = −.58; P = .02) was also found. Conclusion: The proinflammatory status, hyperlipidemia, and metabolic control correlate with uterine blood flow velocity waveforms in women with gestational diabetes.

Characterization of NO-Induced Nitrosative Status in Human Placenta from Pregnant Women with Gestational Diabetes Mellitus

Dysregulation of NO production is implicated in pregnancy-related diseases, including gestational diabetes mellitus (GDM). The role of NO and its placental targets in GDM pregnancies has yet to be determined. S-Nitrosylation is the NO-derived posttranslational protein modification that can modulate biological functions by forming NO-derived complexes with longer half-life, termed S-nitrosothiol (SNO). Our aim was to examine the presence of endogenous S-nitrosylated proteins in cysteine residues in relation to antioxidant defense, apoptosis, and cellular signal transduction in placental tissue from control (n = 8) and GDM (n = 8) pregnancies. S-Nitrosylation was measured using the biotin-switch assay, while the expression and protein activity were assessed by immunoblotting and colorimetric methods, respectively. Results indicated that catalase and peroxiredoxin nitrosylation levels were greater in GDM placentas, and that was accompanied by reduced catalase activity. S-Nitrosylation of ERK1/2 and AKT was increased in GDM placentas, and their activities were inhibited. Activities of caspase-3 and caspase-9 were increased, with the latter also showing diminished nitrosylation levels. These findings suggest that S-nitrosylation is a little-known, but critical, mechanism by which NO directly modulates key placental proteins in women with GDM and, as a consequence, maternal and fetal anomalies during pregnancy can occur.

Impacto de la autoinmunidad antitiroidea positiva en gestantes con hipotiroidismo subclínico

BACKGROUND The impact of subclinical hypothyroidism (SH) and thyroid autoimmunity on obstetric and perinatal complications continues to be a matter of interest and highly controversial. AIM To assess the impact of SH and autoimmunity in early pregnancy on the obstetric and perinatal complications in our population. MATERIAL AND METHOD A retrospective cohort study in 435 women with SH (TSH ranging from 3.86 and 10 μIU/mL and normal FT4 values) in the first trimester of pregnancy. Epidemiological and clinical parameters were analyzed and were related to obstetric and perinatal complications based on the presence of autoimmunity (thyroid peroxidase antibodies [TPO] > 34 IU/mL). RESULTS Mean age was 31.3 years (SD 5.2). Seventeen percent of patients had positive TPO antibodies. Presence of positive autoimmunity was associated to a family history of hypothyroidism (P=.04) and a higher chance of miscarriage (P=.009). In the multivariate analysis, positive TPO antibodies were associated to a 10.25-fold higher risk of miscarriage. No statistically significant associations were found with all other obstetric and perinatal complications. CONCLUSIONS In our region, pregnant women with SH and thyroid autoimmunity had a higher risk of miscarriage but not of other obstetric and perinatal complications.

ACTUALIZACIÓNPatología tiroideaThyroid pathology

The patients history with thyroid disease should be directed to symptoms of thyroid dysfunction and / or malignancy, the exam include mainly thyroid.inspection and palpation Thyroid function is determined by analysis of serum thyrotropin (TSH), free thyroxine (T4) and triiodotiroinine (T3) to avoid interference of situations that alter their binding to proteins. Although initially, is recommended to measure TSH and, depending of results, FT4 and FT3, the measure of these, should be performed if pituitary disease, hyper-or hypothyroidism is suspected. The presence of autoantibodies reflects the presence of autoimmune disease, serum thyroglobulin is the best marker of differentiated thyroid carcinoma and calcitonin of medullary carcinoma. Thyroid ultrasonography is a useful technique for the morphological assessment of the gland, and scintigraphy allows morpho-functional assessment. The fine-needle aspiration biopsies are essential for diagnosis and therapeutic orientation of the thyroid nodule.

Protocolo diagnóstico y terapéutico del bocio

Goiter is defined as any increase in either diffuse or nodular thyroid gland, whatever their cause. Goiter assessment should include complete history and examination, assessment of thyroid function and laboratory tests required to guide the benignity or malignancy of the lesion and potential effects on adjacent structures. As for treatment must be identified considering numerous variations implicated as age and patient history, size and associated symptoms.

Metabolic Control Targets for Patients with Type 1 Diabetes in Clinical Practice

Diabetes and its microand macro-vascular complications constitute one of the principal social-health problems world-wide. It has high impact on the quality of life and prognosis of the individuals affected, as well as high direct and indirect economic costs to the Public Health Service. Following the publication of benchmark studies in the 1990s which indicated that the maintenance of glycaemia levels as close as possible to normality is associated with a lower incidence, progression and severity of the complications, the optimisation of metabolic control has been converted to a core therapeutic objective (DCCT, 1993; Herman, 1999; UKPDS, 1998). The tools for the management of diabetes have advanced spectacularly in these past few years, not only for the control of glycaemia but also for its measurement. As such, currently, there is a wide variety of drugs available with different mechanisms of action which, alone or in combination, enable a reasonable metabolic control in the majority of cases. Although insulin has been used for >80 years, the biggest advances in the mode of use have been over the last two decades. This change has been due, in great part, to: 1) development of new sources of insulin (analogues of insulin) together with the development and fine-tuning of different forms of its administration (continuous subcutaneous insulin infusion; CSII) in search of profiles of activity closer to the normal physiologic state; 2) change in philosophy in the therapeutic planning of diabetes, such that the strategies of coresponsibility and flexibility of life-style have become fundamental aspects; 3) introduction of self-control using capillary glycaemia (SCCG) in daily practice (De Witt & Hirsch, 2003); 4) recent incorporation in clinical practice of the use of glucose sensors, continuous glucose monitoring systems (CGMS) that generate the maximum information on modifications of glucose levels in plasma along the course of the whole day. This review centres on the importance, in clinical practice, of the metabolic control targets for patients with DM type 1. Difficulties in achieving glycaemia goals using multiple insulin injection with new insulin analogues, and modern technologies such as CGMS and CSII are extensively analysed.