Incidence of insulin-dependent diabetes mellitus in Santiago, Chile (1990-1993)

The aim of this study was to determine IDDM incidence in the Metropolitan Region of Chile, during the period 1990-1993 as part of the Multinational Project for Childhood Diabetes (WHO DIAMOND Project Group). The studied population was 1499.784 inhabitants. All children in whom the diagnosis was made between January 1, 1990 and December 31, 1993 were included. We used a retrospective and prospective search and confirmation method, using as data sources public and private hospitals and medical records of Pediatricians. The Juvenile Diabetes Foundation was used as a secondary data source. All cases had at least two confirmation sources. A total of 176 new cases (90 male) were diagnosed in the study period, with an annual incidence of 2.92/100,000 for females and 2.95 for males. The group of children from 10 to 14 years old had the highest incidence rate (4.9/100,000), specially in women (5.25/100,000). The yearly incidence was 1.31 in 1990, 2.71 in 1991, 2.93 in 1992 and 3.7/1000,000 in 1993. It is concluded that the Metropolitan Region has one of the lowest incidences of IDDM in Latin America, although it increased along the study years.     

Genetic factors study in family aggregation of schizophrenia in Santiago, Chile

BACKGROUND: Genetic epidemiological studies indicate that genetic factors contribute to a familial aggregation of schizophrenia. The form of inheritance has not been elucidated but most studies have been done in Caucasian populations. AIM: To study the form of inheritance of schizophrenia in an urban population of Santiago, Chile, containing an admixture of Spanish origin individuals with Southamerican aborigines. SUBJECTS AND METHODS: Forty four randomly selected schizophrenic probands, 22 female, aged 28 to 48 years old, were studied. From them, an extensive genealogical reconstitution was performed. Probands and relatives were interviewed using the structured interview CIDI and DSM-III-R check-list. Schizophrenia was diagnosed using DSM-III-R criteria. Complex segregation analysis was done using Pointer program. RESULTS: The hypothesis of a multifactorial inheritance, without the participation of major genes, could not be rejected. Likewise, the major dominant and co-dominant gene forms of transmission could not be rejected. CONCLUSIONS: Our results show the participation of a major dominant locus and a multifactorial component in the inheritance of schizophrenia, as has been reported elsewhere.     

Insulin-dependent diabetes mellitus presenting with ketoalkalosis in Rett syndrome

A 9-year-old girl with Rett syndrome presented with typical symptoms of insulin-dependent diabetes mellitus. Upon investigation she was found to have a primary respiratory alkalosis associated with diabetes ketoacidaemia. Once non-ketotic normoglycaemia was achieved her respiratory alkalosis persisted. This was felt to be due to an abnormal breathing pattern of hyperventilation punctuated by apnoeas which is associated with Rett syndrome.     

Risk factors for low birth weight and intrauterine growth retardation in Santiago, Chile

An epidemiologic case-control study to ascertain the determinants of low birthweight was carried out in Santiago, Chile, from January to December 1989. The cases were defined as livebirths < 2500 g. The controls were livebirths > or = 2500 g of birthweight. All cases and a random sample (1:1) of controls were selected among 8,254 singleton births occurring at the El Salvador Hospital in the Eastern area of Santiago. These deliveries represented 50% of institutional deliveries in the area. Home deliveries (2%) and private hospital deliveries were not included in the study. Information was obtained from hospital medical records by six trained medical students. Some information could not be obtained from the hospital medical records. Thus the second step in data collection was the tracking of all the selected subjects to their referring neighborhood health centers. For the analysis, the data were divided into 3 case (outcome) categories: 453 subjects were the total case group. From these, 153 were the IUGR case group and 300 were the LBW preterm case group. The general control group consisted of 605 normal birthweight infants. 565 were the IUGR control group and 40 were the preterm control group. A total of 25 risk factors showed a significant crude odds ratio for at least one of the groups. In the multivariate logistic regression analysis eight variables: No. of pregnancies, previous adverse outcomes, previous LBW, pregnancy maternal weight, No. of visits, month of first prenatal care visit, maternal smoking and intrahepatic cholestasis of pregnancy, were significantly associated with LBW after adjustment by confounding. Eight risk factors: IUGR in previous pregnancies, Previous adverse outcome, Maternal smoking, intrahepatic cholestasis, maternal pregnancy weight, maternal height, month first prenatal visit, No. of visit, were significant to IUGR. Only two variables: pregnancy weight, divorced mother, were significantly associated with low birth weight in the preterm group. The most relevant risk factors were included in stepwise logistic regression models carried out for the outcome LBW for the general group, term group and preterm group, in order to adjust by confounding. Adjusted odds ratios were then obtained. Prenatal care related factors and maternal adverse obstetric factors were at higher significance for LBW in the general and IUGR groups. Only nutritional factors were related to LBW in preterm group. Women who delivered a LBW or IUGR infant were more likely to have fewer pregnancies, a history of previous LBW, lower prepregnancy weight and lower gestational weight gain. ICP was associated with an elevated risk of LBW that was independent of gestational age.     

Epidemiology of tension-type headache in Santiago, Chile: a prevalence study

OBJECTIVE: To describe the importance of tension-type headache (TTH) in Santiago, Chile, by analyzing its prevalence, clinical features, and impact by age, gender, and socioeconomic status, using widely accepted international diagnostic criteria. METHODS: In 1993, a representative sample of 1540 adults (older than 14) of the province of Santiago were interviewed using a standard questionnaire. A total of 1385 (89.9% response rate) subjects responded to the survey. Initially, a designated member of each household responded to the questionnaire. Subsequently, each household member with headache was asked to respond to questions about the severity, frequency, location, duration, associated symptoms, and impact in work and social activities of their most frequent headaches. TTH diagnoses were determined in accordance with the International Headache Society criteria of 1988. RESULTS: Total prevalence was found to be 26.9% (95% CI: 24.6-29.3%); 35.2% in females (95% CI: 31.7-38.8%) and 18.1% in males (95% CI: 15.2-21.3%). The prevalence of episodic TTH was 24.3% (95% CI: 22.1-26.7%) and of chronic TTH 2.6% (95% CI: 1.8-3.6%). Overall, and by subtype, prevalence was significantly higher in females (ratio 1:9). There was no significant variation in prevalence by socioeconomic or age group except in chronic TTH, in which there was an increase with age. CONCLUSIONS: TTH is a prevalent condition in a sample of adults of Santiago, similar to that reported in previous studies using similar methodologies. Overall, TTH represents 72.3% of all recurrent headaches.     

The role of immunopathological factors in severe forms of insulin-dependent diabetes mellitus

Immunogrammes of 31 patients with grave forms of insulindependent diabetes mellitus were reviewed. The illness has been characterized as a systemic immunopathologic process combining autoimmune and infectious-and-allergic components realized by organ and tissue abnormalities; it evolves against the manifest background of allergy of both delayed anl immediate types, impairement of the humoral and cell-mediated immunity function, pathogenetic activity of endogenous proteases, the complement system components and interferon.     

Growth factors and the kidney in diabetes mellitus

Nephromegaly and mesangial matrix expansion observed in the diabetic kidney are all clues of a role of growth factors in the pathogenesis of these lesions. A growing body of evidence shows that changes in (1) insulin-like growth factor I regulation, and (2) the transforming growth factor beta loop exist in the kidney in the diabetic hypertrophic kidney and in diabetic glomerulosclerosis. However, other growth factors may be involved in some diabetic renal changes. The abnormalities in growth factor content and regulation, the role of growth factors in the diabetic kidney, and the effect of hyperglycemia and advanced glycosylation end products on growth factors in the kidney are reviewed.     

A newly discovered role of transcription factors involved in pancreas development and the pathogenesis of diabetes mellitus

BACKGROUND: Functional vision loss is a general term used to describe vision loss not associated with organic disease. Such cases are major challenges to the practitioner and demand a special workup. METHODS: Patients may manifest symptoms in typical ways that should alert the examiner to the possibility of functional vision loss. In addition, a variety of techniques help distinguish functional from organic causes of vision loss. These techniques include standard tests that yield characteristic findings in functional vision loss, as well as problem-specific procedures that have the specific aim of detecting functional vision loss. Techniques are described according to whether they are useful in monocular or binocular vision loss and in cases of moderate or severe vision loss. RESULTS: Three cases that illustrate the use of standard and select techniques to detect functional vision loss are presented. Differential diagnosis of functional from organic vision loss and special considerations in the management of patients with functional vision loss are also discussed. CONCLUSIONS: Although it is necessary to rule out underlying pathology in all cases of vision loss, a variety of techniques can provide positive evidence of functional vision loss.     

Endothelin-1 and its role in diabetes mellitus

Endothelin-1 is mainly synthesised by the vascular endothelial cells and acts on the vascular smooth muscle. There are special endothelin receptors, endothelin receptor-A and endothelin receptor-B expressed on the vascular smooth muscle cells. Endothelin-1 through second messengers mobilises the intracellular calcium storage. The level of endothein-1 was found to be higher than normal in several diseases. Because of its vasoconstrictor and mitogenic effects it plays a role in the development of vascular diseases. The most severe and most frequent complications of diabetes mellitus are micro- and macroangiopathy. The authors summarise the physiological functions of endothelin-1 and its role in the development of diabetic angiopathy.     

Insulin-dependent diabetes and psychiatric pathology: general clinical and epidemiologic review

The objective was to determine the diagnostic sensitivity of spinal and femoral dual x-ray absorptiometry (DXA) and to study whether a combination of both sites may enhance discriminatory capability in regard to the presence of vertebral fractures. Spinal and femoral DXA were obtained in 324 postmenopausal women, of whom 90 had at least one vertebral fracture. Age-adjusted logistic regression analyses, ROC analyses, and sensitivity-specificity statistics were used to assess the discriminatory ability of spinal and femoral bone density (BMD) alone and in combination. The age-adjusted odds ratios per standard deviation decrease in BMD (OR) for spinal and femoral measurements were comparable (Ward's triangle: OR = 1.62; femoral neck: OR = 1.51; total hip: OR = 1.47; spine: OR = 1.34). Combining spinal and femoral bone density measurements did not improve diagnostic sensitivity of DXA considerably as compared to using BMD of a single site and adjusting the "fracture threshold." The conclusion drawn is that spinal and femoral BMD measurements using DXA have a comparable diagnostic sensitivity for vertebral fracture discrimination. Different individuals at risk for osteoporosis may be identified using both methods. The clinical usefulness of a combination of two bone density measurements needs further study in a prospective setting.     

Putative environmental factors in Type 1 diabetes

Various environmental triggers, e.g. certain viruses and dietary factors, are thought to initiate the autoimmune process, leading to the destruction of pancreatic beta-cells and consequent Type 1 diabetes. A genetic predisposition is another prerequisite allowing the autoimmune process to progress. Twin studies, major geographical variations in incidence rates, temporal trends in the incidence and findings in migrant studies indicate that environmental factors play a crucial role in the development of Type 1 diabetes. In the present review the major focus is on dietary factors, and among them particularly the possible role of cow's milk proteins. The cow's milk and Type 1 diabetes hypothesis was developed more than 10 years ago, and the issue is still not settled. Among viral infections, enteroviruses are today the most interesting group of viruses in this respect, as recent prospective studies indicate that these viruses may trigger and potentiate existing beta-cell autoimmunity. Among toxins, particularly N-nitroso compounds are of potential interest, as they are probably involved in the aetiology of some cases. Finally, psychosocial factors and the interaction between genetic predisposition and environmental factors are briefly discussed.     

The School of Medical Sciences of the University of Santiago de Chile

The Medical Sciences School of the University of Santiago de Chile, is an institution inserted in the occidental culture and therefore on its conceptions and traditions. It subscribes the Principles defined in the Universal Declaration of the Human Rights of the United Nations and especially the importance of the human person, as an entity irrepetible, different to others. The human rights are over the institutions, the society and the laws of science. The Faculty considers the family as the cell or natural and fundamental element for the development of the human being in the society. It defines its historic mission as the search of the truth and the achievement of a society in pro of the welfare and health of the people in a frame of excellence, justice, humanism, efficiency and participation. As an expression of the cultural patrimony it should create and transfer knowledge. As guarantor of the ethical principles it should protect the dignity that emanates from the transcendent nature of the person and its moral principles and therefore its right to life, justice, freedom, equality, health, education, and happiness. As a paradigm of progress it must be involved in modernization and should impulse the development. As an entity committed with Society it should participate in the search of solutions for politics and programs looking for a higher level of life and a better model of health. The profile of our graduated students will identify them due to their profound spirit of welfare of the person, his family, his community, ethical sense, solidarity, justness and humanity, their orientation to the community and the environment with a solid professional formation in the strategy of Primary Health Care. They will provide education in health for the whole family in order to improve a better way of life. They will be trained to detect and solve the risks of individual, communities and environment. Research is also a priority of the Faculty in order to contribute to solve the problems of health of the Nation, since there is no development without education and there is no education neither development without health. For the Faculty the achievement of these purposes is mandatory and we will make them reality through the Prometeo Project 1997-2001.     

Risk factors for above-knee amputations in diabetes mellitus

BACKGROUND: Above-knee amputation (AKA) is a common complication in diabetics, mostly after one or more lower level amputations (LEAs) have been done. The aim of this study was to identify risk factors for AKAs among diabetics. METHODS: We abstracted 1,800 medical records of hospitalizations for LEA. Kaplan's comorbidity classification was used to rank disease severity. We used both univariate and multivariate models to identify risk factors for AKA. RESULTS: Of the 1,043 diabetic amputees in this study, 22% had AKA. Variables associated with AKA were locomotor impairment, severe anemia, history of lower extremity bypass surgery, body mass index (BMI) < 20 kg/m2, female sex, cerebrovascular disease, cardiovascular disease, and SGOT > 40 U/L. CONCLUSIONS: Most of these risk factors represent end-stage processes and do not have good treatment alternatives. Perhaps one of the practical applications of these data is not to describe risk of proximal amputations but instead to look more closely at candidates who should be considered for distal procedures.