[The importance of updating criteria of altered fasting glucose levels in Mexico]

OBJECTIVE

To evaluate the impact of applying the 2003-ADA-proposed lower normality value of fasting glucose (FG) on impaired fasting glucose (IFG), prevalence and the agreement between diagnostic categories from ADA-2003 FG values and WHO two hours oral glucose tolerance test (OGTT) current criteria in a Mexican population with suspected diabetes.

METHODS

A retrospective cross sectional study was undertaken. We analyzed fasting and 2 hours post load glucose values of 2062 patients and compared diagnostic categories on the basis of different criteria.

RESULTS

Considering fasting values, prevalence of IFG changed from 17.7 % to 41.3 % when applying ADA-1997 or ADA-2003 criteria, respectively. Furthermore, based on their OGTT values (WHO-1999), 63 % the 852 IFG patients identified by ADA-2003 criteria were reclassified as having diabetes (26.1 %) or IGT (36.9 %). A heavy kappa test showed a moderate diagonal agreement of 0.43260 (CI 95 % = 0.43214-0.43305) between diagnostic categories from ADA-2003 with FG and OGTT values and WHO current criteria.

CONCLUSIONS

The lower ADA-2003 criteria for IFG identifies a higher ratio of patients with IGT or DM.

Probiotics and autoimmunity: an evolutionary perspective

Probiotics are microorganisms that have demonstrated beneficial effects on human health. Probiotics are usually isolated from the commensal microflora that inhabits the skin and mucosas. We propose that probiotics represent the species of microorganisms that have established a symbiotic relationship with humans for the longest time. Cultural practices of ancient human societies used to favor that symbiosis and the transmission of probiotics from generation to generation. New practices, introduced as a result of industrialization, such as childbirth by surgical delivery, ingestion of pasteurized and synthetic compounds-supplemented food, cleaner homes, indiscriminate use of antibiotics and so on, have led in recent years to the replacement of probiotics by other microorganisms that are not as well adapted to the microenvironments of the human body. These newly settled microorganisms lack many of the beneficial effects of probiotics. Our hypothesis is that the sudden change (from an evolutive perspective) in human intestinal microflora may importantly contribute to the rise in the incidence of autoimmune diseases, observed in the last half a century.

Indications, usage, and dosage of the transfer factor

The transfer factor (TF) was described in 1955 by S. Lawrence. In 1992 Kirkpatrick characterized the specific TF at molecular level. The TF is constituted by a group of numerous molecules, of low molecular weight, from 1.0 to 6.0 kDa. The 5 kDa fraction corresponds to the TF specific to antigens. There are a number of publications about the clinical indications of the TF for diverse diseases, in particular those where the cellular immune response is compromised or in those where there is a deficient regulation of the immune response. In this article we present our clinical and basic experiences, especially regarding the indications, usage and dosage of the TF. Our group demonstrated that the TF increases the expression of IFN-gamma and RANTES, while decreases the expression of osteopontine. Using animal models we have worked with M. tuberculosis, and with a model of glioma with good therapeutic results. In the clinical setting we have worked with herpes zoster, herpes simplex type I, herpetic keratitis, atopic dermatitis, osteosarcoma, tuberculosis, asthma, post-herpetic neuritis, anergic coccidioidomycosis, leishmaniasis, toxoplasmosis, mucocutaneous candidiasis, pediatric infections produced by diverse pathogen germs, sinusitis, pharyngitis, and otits media. All of these diseases were studied through protocols which main goals were to study the therapeutic effects of the TF, and to establish in a systematic way diverse dosage schema and time for treatment to guide the prescription of the TF.

[Prevalence of hepatitis C virus in the blood bank at Centro Médico Nacional La Raza]

INTRODUCTION

There are no records on the prevalence of infection by HCV in Mexican population. The central area of Mexico is a highly dense demographic zone and is the influence area of the second blood bank in Latin America in terms of affluence.

MATERIAL AND METHODS

We prospectively studied the prevalence and genotypes of HCV infection in 5105 individuals attending the Central Blood Bank of Centro Médico Nacional La Raza regardless if they were accepted or rejected as donors. We applied a quimiolumiscence assay as a screening test. A recombinant immunoassay (RIBA) and a qualitative polymerase chain reaction (PCR) were performed as confirmatory tests and to detect viremia, respectively. Virus genotype was identified by means of a Line Immuno Probe Assay in PCR positive samples.

RESULTS

The overall prevalence of HCV infection was 0.195% (10/5105). Viremia was detected in 90% of the subjects. The prevalence of accepted donors (0.087%) was significantly lower (p = 0.017) than that of the rejected ones (0.421%). Among viremic subjects, 60 % were infected with genotype 2 and 40% with a subtype combination (a/b) of genotype 1.

DISCUSSION

The prevalence of HCV infection in our population was significantly lower than the world mean prevalence estimated in 3 %. A higher prevalence of genotype 2 in asymptomatic individuals contrasts with previous studies with a selected population where genotype 1 prevailed.