Consumo de café como factor protector de injuria hepática en adultos

Determinar si el consumo de café es un factor protector de injuria hepática en adultos hospitalizados en los servicios de Medicina Interna 6C y Cirugía General 4B del Hospital Nacional Edgardo Rebagliati Martins. MATERIAL Y MÉTODO: Se llevó a cabo un estudio observacional, analítico, retrospectivo, casos y controles. Se evaluó a 160 pacientes, 60 fueron excluidos debido a que no cumplían con los criterios de selección, quedando un total de 100 pacientes. De este total, se dividieron en 2 grupos: 50 consumían café (grupo expuesto) y 50 no consumían café (grupo no expuesto), y se analizó el perfil hepático en ambos grupos. El periodo de estudio fue de Julio - Diciembre 2016. RESULTADOS: Se analizó si el consumo de café es un factor protector de injuria hepática en pacientes hospitalizados en el Hospital Nacional Edgardo Rebagliati Martins entre Julio a Diciembre 2016. Del grupo que consume café, el 76% son de sexo femenino y el 24% de sexo masculino; presentan una edad promedio de 62.5 años, tienen un tiempo de consumo promedio de 11.6 años y consumen un promedio de 10.9 tazas por semana. Del total de pacientes que consumen café, el 76% presentaron niveles séricos bajos de marcadores de injuria hepática, a comparación del grupo que no consume café, presentando sólo el 40% niveles bajos de marcadores de injuria hepática, encontrándose una relación altamente significativa (p= 0.001 < 0.01). El tipo de café consumido con mayor frecuencia fue el café con cafeína en un 74%. En pacientes que consumen café con cafeína el 75.7 % tuvieron niveles séricos disminuidos de transaminasas a diferencia de 76.9 % en aquellos que consumen café descafeinado, siendo esta una relación no significativa (p= 0.920 > 0.05). Es decir, el contenido de cafeína en el café no determinó la disminución de los niveles séricos de transaminasas. CONCLUSIONES: El consumo de café es un factor protector de injuria hepática con alta significancia estadística, independientemente del contenido de cafeína.To determine whether coffee consumption is a protective factor of liver injury in adults hospitalized in the Internal Medicine 6C and General Surgery 4B departments of the Hospital Nacional Edgardo Rebagliati Martins. MATERIAL AND METHOD: An observational, analytical, retrospective, case-control study was conducted. A total of 160 patients were evaluated, 60 were excluded because they did not meet the selection criteria, leaving a total of 100 patients. The remaining patients were divided into 2 groups: 50 consumed coffee and 50 did not consume coffee; and their liver enzymes were analyzed. The study period was from July to December 2016. RESULTS: It was analyzed whether coffee consumption is a protective factor of liver injury in adults hospitalized in the Hospital Nacional Edgardo Rebagliati Martins from July to December 2016. Of the group that consumes coffee, 76% are female and 24% are male; the average age was 62.5 years, the average consumption time was 11.6 years and the average cups consumed per week was 10.9. Of the total number of patients consuming coffee, 76% had low serum levels of markers of liver injury, compared to the non-consuming coffee group, with only 40% having low levels of markers of liver injury, being this a highly significant relation (p = 0.001 <0.01). The type of coffee most frequently consumed was caffeinated coffee in 74% of the cases. In patients consuming caffeinated coffee, 75.7% had decreased serum levels of transaminases, as compared to 76.9% in those who consumed decaffeinated coffee, being this a non-significant relation (p = 0.920> 0.05). This means that the caffeine content in coffee did not determine the decrease in serum levels of transaminases. CONCLUSIONS: Coffee consumption is a protective factor of liver injury in adults with high statistical significance, regardless of caffeine content

A rare case of autoimmune dysglycemia syndrome associated with systemic lupus erythematosus and dermatomyositis

"Autoimmune dysglycemia syndrome (ADS) is a rare condition that presents as episodes of hypoglycemia as well as hyperglycemia and is classified as insulin autoimmune syndrome (IAS) and type B insulin resistance (TBIR). Autoimmunity plays a key role in the pathogenesis ofthis disorder, as evidenced by the presence of autoantibodies against endogenous insulin or the insulin receptor, and by its association with rheumatologic disorders. Treatment usually includes glycemic control and immunomodulatory agents. We report a case of a 31-year-old woman who was admitted for severe hypoglycemia. Further workup revealed underlying systemic lupus erythematosus (SLE) with renal involvement. During hospitalization, she continued to experience episodes of fasting hypoglycemia, as well as episodes of postprandial hyperglycemia. Hypoglycemia associated with a high serum insulin concentration and positive anti-insulin antibodies were consistent with IAS. Likewise, hyperglycemia and hypoglycemia in association with weight loss, acanthosis nigricans, polycystic ovarian syndrome, and normotriglyceridemia strongly suggested TBIR, although testing for antibodies against the insulin receptor was not available in Peru. Immunosuppressive therapy and metformin were indicated, resulting in remission of SLE and ADS. Years later, the patient exhibited features of dermatomyositis, such as Raynaud’s phenomenon, muscular weakness, heliotrope exanthema, and elevated muscle enzymes. Once again, the patient received immunosuppressive therapy. ADS is an infrequent cause of hypoglycemia, and the coexistence of its two pathophysiological mechanisms in a patient with SLE and subsequent development of dermatomyositis is even more rare. Our case is the first one reported describing this association.