Maristela de Oliveira Beck

High‐normal levels of albuminuria predict the development of micro‐ and macroalbuminuria and increased mortality in Brazilian Type 2 diabetic patients: an 8‐year follow‐up study

Aim  To analyse the risk factors for the development of micro‐ and macroalbuminuria and mortality rates in a cohort of normoalbuminuric Type 2 diabetes mellitus (DM) patients.

Urinary Albumin Excretion Rate and Glomerular Filtration Rate in Single-Kidney Type 2 Diabetic Patients

OBJECTIVE To evaluate the urinary albumin excretion rate (UAER) and the glomerular filtration rate (GFR) of single-kidney type 2 diabetic patients (SKD) and of single-kidney non-diabetic patients (SKN). RESEARCH DESIGN AND METHODS Patients who had only one kidney for at least 5 years, with no renal disease or hypertension at the time of the nephrectomy and with no calculus or systemic disease at the time of the evaluation, were included in this controlled cross-sectional study A total of 20 SKD (8 men, age 62 ± 9 years; diabetes duration 8.5 ± 7 years), 17 SKN (2 men, age 57 ± 13 years), and 184 type 2 diabetic patients who were matched to the single-kidney diabetic group for age, sex, and BMI were studied. UAER was measured by immunoturbidimetry in timed 24-h sterile urine, and GFR was determined by the 51Cr-EDTA single-injection method. RESULTS SKD patients presented a higher proportion (8 of 20, 40%) of microalbuminuria (UAER 20-200 μg/min) than SKN patients (3 of 17, 17.6%) and type 2 diabetic patients (37 of 184, 20%). SKD patients presented a higher proportion of macroalbuminuria (UAER >200 μg/min; 6 of 20, 30%) than SKN patients (1 of 17, 6%) but were similar to type 2 diabetic patients (43 of 184, 23%). The GFRs of normoalbuminuric SKN (71.7 ± 21.4 ml · min−1 · 1.73 m−2) and SKD patients (73.0 ± 21.5 ml · min−1 · 1.73 m−2) were similar but higher than the one-kidney GFR (GFR ÷ 2) of the age-, sex-, and BMI-matched normal individuals (50.5 ± 9.0 ml · min−1 · 1.73 m−2) and normoalbuminuric type 2 diabetic patients (54.0 ± 11.6 ml · min−1 · 1.73 m−2). CONCLUSIONS Increased GFR related to single-kidney status confers an increased risk of developing renal disease in the presence of diabetes.

Transverse myelitis associated to HCV infection

Complications involving the central nervous system in patients suffering from hepatitis C virus (HCV) infection have been rare. Among them, it appears the transverse myelitis, which has already been reported in likely association with HCV. This paper presents the case study of a 65-year-old woman who developed cervical transverse myelitis linked to chronic HCV infection and anti-HCV antibodies in the spinal fluid, being excluded other etiologies for transverse myelitis. Current evidence has reinforced the likely association between chronic HCV infection and transverse myelitis, especially as recurrent manifestations of the disease. These findings reveal the need for more searching to establish the causal relationship between transverse myelitis and hepatitis C.

Value of diagnostic tools for myocardial ischemia used in routine clinical practice to predict cardiac events in patients with type 2 diabetes mellitus: a prospective study

OBJECTIVE To analyze tests used in routine clinical practice for the diagnosis of myocardial ischemia to predict the development of cardiac events in type 2 diabetic patients. METHODS The occurrence of cardiac events (new myocardial infarct, myocardial re-vascularization procedures, congestive heart failure, acute pulmonary edema, sudden death, and death after myocardial infarction or pulmonary edema) were prospectively assessed in a cohort of 135 type 2 diabetic patients after up to seven years of follow-up. At baseline, coronary artery disease was assessed by the WHO cardiovascular questionnaire, resting electrocardiogram, and stress myocardial scintigraphy. RESULTS Forty-eight cardiac events were observed in 41 patients (10.5 events/100 patients-year). In a Coxs proportional-hazard model only the presence of symptoms of coronary artery disease on the WHO cardiovascular questionnaire alone (RR = 2.13, 95% CI 1.11-4.07, P= 0.022) or in combination with abnormalities on resting ECG (RR= 2.03, 95% CI 1.05-3.92, P= 0.034) or on myocardial scintigraphy (RR= 1.89, 95% CI 1.001-3.57, P= 0.050) predicted cardiac events, adjusted for fasting plasma glucose, mean blood pressure, body mass index, peripheral vascular disease and diabetic nephropathy. CONCLUSION The WHO cardiovascular questionnaire, a simple tool for the diagnosis of coronary artery disease, is a significant predictor of cardiac events in type 2 diabetic patients.

Neurofibroma de tireóide em uma paciente com neurofibromatose tipo 1

The neurofibromatosis type 1 (NF1), also known as von Recklinghausens disease, is an autosomal dominant disorder, with high degree of variability of clinical expression, usually involved with formation of tumors, with benign origin in the majority of cases mainly localized in the region of the head and neck and rarely incident in the thyroid area. However, the association with medullary carcinoma of the thyroid (MCT) exists in literature and needs to be excluded. We report a case of a patient with NF1, nonfunctional thyroid nodule and obstructive symptoms. Surgical resection of lesion was performed, with histopathologic findings compatible with neurofibroma in thyroid tissue. This case is relevant not only because of the rarity of the presentation of NF1, but also due to the likely association with MCT, an aggressive tumor that can be cured by surgery.