Some pleural effusions labeled as idiopathic could be produced by the inhalation of silica

Objectives: Exposure to silica nanoparticles has been associated with pleural effusions (PEs) in animal models and case series. We hypothesized that some PEs labelled as “idiopathic” could, in fact, be secondary to inhalation of silica. Methods: A retrospective case control study was designed utilizing a prospectively maintained pleural database. Cases, represented by idiopathic PEs, were matched by age and gender to control patients who had been diagnosed with malignant, cardiac, or infectious PEs. A survey consisting of questions about occupational life and possibility of silica inhalation was conducted. In a subgroup of patients, pleural fluid concentrations of silica were quantified by plasma atomic emission spectrometry analysis. Also, the pleural biopsy of a silica-exposed case was subjected to an energy dispersive X-ray spectroscopy (EDX) to identify the mineral, the size of which was determined by electron microscopy. Results: A total of 118 patients (59 cases and 59 controls) completed the survey. There were 25 (42%, 95% CI 31–55%) and 13 (22%, 95% CI 13–34%) silica-exposed workers in case and control groups, respectively. The exposure attributable fraction was 0.62 (95% CI 0.14–0.83). Four of eight exposed cases showed detectable levels of silica in the pleural fluid (mean 2.37 mg/L), as compared to none of 16 tested controls. Silica nanoparticles of 6–7 nm were identified in the pleural biopsy of an exposed case patient. Conclusions: It is plausible that some idiopathic PEs could actually be caused by occupational silica inhalation

Vitamin D deficiency is associated with poorer satisfaction with diabetes-related treatment and quality of life in patients with type 2 diabetes: a cross-sectional study

BACKGROUND: In this cross-sectional study, we assessed the possible association of vitamin D deficiency with self-reported treatment satisfaction and health-related quality of life in patients with type 2 diabetes. METHODS: We performed a sub-analysis of a previous study and included a total of 292 type 2 diabetic patients. We evaluated treatment satisfaction and health-related quality of life through specific tools: the Diabetes Treatment Satisfaction Questionnaire and the Audit of Diabetes-Dependent Quality of Life. Vitamin D deficiency was defined as 25 (OH) D serum levels < 15 ng/mL. RESULTS: Multivariable linear regression models were used to estimate the relationship of vitamin D deficiency with both outcomes once adjusted for self-reported patient characteristics. Vitamin D deficiency was significantly associated with the final score of the Diabetes Treatment Satisfaction Questionnaire and the single 'diabetes-specific quality of life' dimension of the Audit of Diabetes-Dependent Quality of Life (p = 0.0198 and p = 0.0070, respectively). However, lower concentrations of 25-OH vitamin D were not associated with the overall quality of life score or the perceived frequency of hyperglycaemia and hypoglycaemia. CONCLUSIONS: Our study shows the association between vitamin D deficiency and both the self-reported diabetes treatment satisfaction and the diabetes-specific quality of life in patients with type 2 diabetes

Vitamin D deficiency is associated with the presence and severity of diabetic retinopathy in type 2 Diabetes Mellitus

There is very few evidences on the role of vitamin D in the development of diabetic retinopathy. The aim of the current study was to explore whether there is an association of vitamin D status and diabetic retinopathy in type 2 diabetes. Two groups of patients were selected: 139 and 144 patients with and without retinopathy, respectively, as assessed by an experienced ophthalmologist. Subjects with advanced late diabetic complications were excluded to avoid confounding biases. 25-Hydroxy-vitamin D3 (25(OH)D) concentrations and vitamin D deficiency were associated with the presence of diabetic retinopathy. Additionally, patients with more advanced stages of retinopathy (grades 24) had lower concentrations of 25(OH)D and were more frequently vitamin D deficient as compared with patients not carrying this eye complication. In conclusion, our study confirms the association of vitamin D deficiency with the presence and severity of diabetic retinopathy in type 2 diabetes. Further experimental and prospective studies on this issue are clearly warranted.The authors are grateful to all staff members of the institutions involved in the study that contributed to the recruitment of participants and supported our activities. This study was supported by Grant PS09/01035 from Instituto de Salud Carlos III, Ministry of Economy and Competitiveness, Spain. Nuria Alcubierre holds a predoctoral fellowship also from Instituto de Salud Carlos III FI11/0008

Vitamin D Deficiency Is Associated with the Presence and Severity of Diabetic Retinopathy in Type 2 Diabetes Mellitus

There is very few evidences on the role of vitamin D in the development of diabetic retinopathy. The aim of the current study was to explore whether there is an association of vitamin D status and diabetic retinopathy in type 2 diabetes. Two groups of patients were selected: 139 and 144 patients with and without retinopathy, respectively, as assessed by an experienced ophthalmologist. Subjects with advanced late diabetic complications were excluded to avoid confounding biases. 25-Hydroxy-vitamin D 3 (25(OH)D) concentrations and vitamin D deficiency were associated with the presence of diabetic retinopathy. Additionally, patients with more advanced stages of retinopathy (grades 2-4) had lower concentrations of 25(OH)D and were more frequently vitamin D deficient as compared with patients not carrying this eye complication. In conclusion, our study confirms the association of vitamin D deficiency with the presence and severity of diabetic retinopathy in type 2 diabetes. Further experimental and prospective studies on this issue are clearly warranted

Calcium phosphate product is associated with subclinical carotid atherosclerosis in type 2 diabetes

Aims. To assess whether circulating 25-hydroxyvitamin D3 (25OHD) and mineral metabolism-related factors (serum phosphate, calcium, and parathormone) are associated with subclinical carotid atherosclerosis (SCA), defined as the presence of carotid atherosclerotic plaques (main study outcome), in patients with type 2 diabetes mellitus (T2DM) without kidney disease or previous cardiovascular disease. Methods. We undertook a post hoc analysis of a cross-sectional study in adults with T2DM in whom we evaluated SCA. A total of 303 subjects with T2DM were included. Clinical variables and carotid ultrasound imaging were obtained. Results. We found no association of 25OHD with the presence of SCA. However, calcium phosphate (CaP; mg2/dL2) product was positively associated with the presence of carotid plaques (ORadj = 1.078; 95% CI: 1.017–1.142). An inverse association was observed between higher levels of 25OHD (≥30 ng/mL versus <20 ng/mL concentrations) and common carotid intima-media thickness (cIMT; mm) (βadj ± SE = −0.055 ± 0.024). We conclude that the CaP product is independently associated with the presence of established subclinical carotid atherosclerosis in patients with T2DM.This study was supported by Grants PS09/01035 and PI15/ 00625 from Instituto de Salud Carlos III, Ministry of Economy and Competitiveness, Spain. CIBERDEM is an initiative from Instituto de Salud Carlos III (Plan Nacional de I+D+I and Fondo Europeo de Desarrollo Regional). Minerva Granado-Casas holds a predoctoral fellowship from Ministerio de Educación, Cultura y Deporte, FPU15/03005

Insulin secretion in patients with latent autoimmune diabetes (LADA): half way between type 1 and type 2 diabetes: action LADA 9

Background: The study of endogenous insulin secretion may provide relevant insight into the comparison of the natural history of adult onset latent autoimmune diabetes (LADA) with types 1 and 2 diabetes mellitus. The aim of this study was to compare the results of the C-peptide response to mixed-meal stimulation in LADA patients with different disease durations and subjects with type 2 and adult-onset type 1 diabetes. Methods: Stimulated C-peptide secretion was assessed using the mixed-meal tolerance test in patients with LADA (n = 32), type 1 diabetes mellitus (n = 33) and type 2 diabetes mellitus (n = 30). All patients were 30 to 70 years old at disease onset. The duration of diabetes in all groups ranged from 6 months to 10 years. The recruitment strategy was predefined to include at least 10 subjects in the following 3 disease onset categories for each group: 6 to 18 months, 19 months to 5 years and 5 to 10 years. Results: At all time-points of the mixed-meal tolerance test, patients with LADA had a lower stimulated C-peptide response than the type 2 diabetes group and a higher response than the type 1 diabetes group. The same results were found when the peak or area under the C-peptide curve was measured. When the results were stratified by time since disease onset, a similar pattern of residual insulin secretory capacity was observed. Conclusions: The present study shows that the magnitude of stimulated insulin secretion in LADA is intermediate between that of type 1 and type 2 diabetes mellitus

Aproximación a la metodología basada en árboles de decisión (CART): Mortalidad hospitalaria del infarto agudo de miocardio Approach to the methodology of classification and regression trees

Objetivo: : Realizar una aproximación a la metodología de árboles de decisión tipo CART (Classification and Regression Trees) desarrollando un modelo para calcular la probabilidad de muerte hospitalaria en infarto agudo de miocardio (IAM). Método: Se utiliza el conjunto mínimo básico de datos al alta hospitalaria (CMBD) de Andalucía, Cataluña, Madrid y País Vasco de los años 2001 y 2002, que incluye los casos con IAM como diagnóstico principal. Los 33.203 pacientes se dividen aleatoriamente (70 y 30 %) en grupo de desarrollo (GD = 23.277) y grupo de validación (GV = 9.926). Como CART se utiliza un modelo inductivo basado en el algoritmo de Breiman, con análisis de sensibilidad mediante el índice de Gini y sistema de validación cruzada. Se compara con un modelo de regresión logística (RL) y una red neuronal artificial (RNA) (multilayer perceptron). Los modelos desarrollados se contrastan en el GV y sus propiedades se comparan con el área bajo la curva ROC (ABC) (intervalo de confianza del 95%). Resultados: En el GD el CART con ABC = 0,85 (0,86-0,88), RL 0,87 (0,86-0,88) y RNA 0,85 (0,85-0,86). En el GV el CART con ABC = 0,85 (0,85-0,88), RL 0,86 (0,85-0,88) y RNA 0,84 (0,83-0,86). Conclusiones: Los 3 modelos obtienen resultados similares en su capacidad de discriminación. El modelo CART ofrece como ventaja su simplicidad de uso y de interpretación, ya que las reglas de decisión que generan pueden aplicarse sin necesidad de procesos matemáticos.Objective: To provide an overview of decision trees based on CART (Classification and Regression Trees) methodology. As an example, we developed a CART model intended to estimate the probability of intrahospital death from acute myocardial infarction (AMI). Method: We employed the minimum data set (MDS) of Andalusia, Catalonia, Madrid and the Basque Country (2001-2002), which included 33,203 patients with a diagnosis of AMI. The 33,203 patients were randomly divided (70% and 30%) into the development (DS; n = 23,277) and the validation (VS; n = 9,926) sets. The CART inductive model was based on Breiman's algorithm, with a sensitivity analysis based on the Gini index and cross-validation. We compared the results with those obtained by using both logistic regression (LR) and artificial neural network (ANN) (multilayer perceptron) models. The developed models were contrasted with the VS and their properties were evaluated with the area under the ROC curve (AUC) (95% confidence interval [CI]). Results: In the DS, the CART showed an AUC = 0.85 (0.86-0.88), LR 0.87 (0.86-0.88) and ANN 0.85 (0.85-0.86). In the VS, the CART showed an AUC = 0.85 (0.85-0.88), LR 0.86 (0.85-0.88) and ANN 0.84 (0.83-0.86). Conclusions: None of the methods tested outperformed the others in terms of discriminative ability. We found that the CART model was much easier to use and interpret, because the decision rules generated could be applied without the need for mathematical ca