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    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">INTRODUCTION</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">In the general population in Spain&#44; the prevalence of hepatitis C virus &#40;HCV&#41; antibodies ranges between 1&#46;6&#37; and 2&#46;6&#37;&#44;<span class="elsevierStyleSup">1</span> with rates of 2&#37;-7&#37; reported for hepatitis B virus &#40;HBV&#41;&#46;<span class="elsevierStyleSup">2</span> The incidence rate of syphilis in 2010 was 6&#46;39&#47;100&#160;000 inhabitants&#44; and the Canary Islands had the highest syphilis rate in Spain &#40;12&#46;71&#47;100&#160;000&#41;&#46;<span class="elsevierStyleSup">3</span></p><p class="elsevierStylePara">The prevalence of chronic HCV infection in patients with stage 5 chronic kidney disease is higher than in the general population&#46; In patients on haemodialysis&#44; the prevalence rate is estimated at 13&#37;&#44; with a wide variability among geographic regions &#40;1&#37;-70&#37;&#41;<span class="elsevierStyleSup">4</span> and among dialysis units within the same country&#46; In Spain&#44; the prevalence of HCV infection in patients on haemodialysis in 1997-2001 was estimated at 22&#37;&#46;<span class="elsevierStyleSup">5</span></p><p class="elsevierStylePara">In Greece&#44; 5&#37; of patients on haemodialysis are positive for hepatitis B surface antigen&#46;<span class="elsevierStyleSup">6</span> In addition&#44; a recent publication showed that all diabetic patients between the ages of 19 and 59 years should receive the hepatitis B vaccine&#44; leaving the vaccination of patients older than 60 years of age up to the criteria of the attending physician&#46;<span class="elsevierStyleSup">7</span></p><p class="elsevierStylePara">In a review of the relevant medical literature&#44; we have found no information regarding the incidence of syphilis in chronic renal failure patients&#46;</p><p class="elsevierStylePara">With this in mind&#44; the objective of our study was to evaluate the percentage of patients with positive serological tests for hepatitis B and C&#44; human immunodeficiency virus &#40;HIV&#41;&#44; and syphilis in the initial assessment of patients referred to external consultation for diabetic nephropathy&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">PATIENTS AND METHOD</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Ours was a retrospective study of the serological tests requested for diabetic patients referred for an evaluation for diabetic nephropathy upon their first visit to nephrological external consultations &#40;southern region of Grand Canary Island&#41;&#46; We compiled the results of serological analyses supplied by the microbiology department at our hospital &#40;started 5 July 2007&#41; until the study date &#40;10 November 2011&#41;&#46; Serology tests had been requested for a total of 500 patients &#40;297 males and 203 females&#41; within this period&#46; However&#44; our study did not include all patients evaluated for the first time in external consultations for diabetic nephropathy during this period&#44; only those requested in the name of the attending physician&#44; since many requests are made by residents on rotation in various medical specialties&#46; We also compiled biochemical results from urine and blood tests taken on the same date as the serology tests for each patient&#46; For hepatitis B&#44; we examined the results for hepatitis B surface antigen &#40;HBsAg&#41;&#44; total antibodies against core antigen &#40;anti-HBc&#41;&#44; IgM antibodies against core antigen of the hepatitis B virus &#40;anti-HBcIgM&#41;&#44; &#8216;e&#8217; antigen &#40;HBeAg&#41;&#44; antibodies against e antigen &#40;anti-HBe&#41;&#44; and antibodies against hepatitis B surface antigen &#40;anti-HBs&#41;&#46; In cases in which the value for HBsAg was very low and we had to rule out a false positive&#44; we performed a confirmation test for surface antigen &#40;neutralisation&#41;&#46; For hepatitis C&#44; we examined levels of hepatitis C antibodies &#40;anti-HCV&#41;&#44; and if the test was positive&#44; we performed a confirmation test using a LIA<span class="elsevierStyleSup">&#174;</span> line immunoassay test in order to rule out a false positive&#46; For HIV&#44; some patients were only tested for antibodies &#40;anti-HIV&#41;&#44; and more recent patients were tested for both anti-HIV and p24 antigen&#44; which allows for early detection of cases in which antibodies are still undetectable&#46; In accordance with laboratory protocol&#44; in cases of positive test results for anti-HIV&#44; we performed a confirmation test using LIA<span class="elsevierStyleSup">&#174;</span> line immunoassay&#46; For syphilis&#44; a rapid plasma reagin test &#40;RPR&#41;&#44; was performed&#44; as well as a fluorescent treponemal antibody test &#40;FTA&#41;&#59; to rule out false positives&#44; a confirmation test using LIA<span class="elsevierStyleSup">&#174;</span> line immunoassays was performed&#46;</p><p class="elsevierStylePara">Patients were subdivided into three categories based on hepatitis B serology results&#58; chronic hepatitis B &#40;HBsAg and anti-HBc positive&#44; with or without HBeAg&#41;&#44; resolved or cured hepatitis B &#40;HBsAg negative and anti-HBc positive&#41;&#44; and vaccinated against hepatitis B &#40;anti-HBs positive with seronegativity for HBsAg and anti-HBc&#41;&#46;</p><p class="elsevierStylePara">We reviewed the clinical histories of all patients with positive serology results &#40;transaminase&#44; whether or not treatment was given and response to treatment&#44; and ultrasound with or without signs of portal hypertension&#41;&#46;</p><p class="elsevierStylePara">We used SPSS statistical software&#44; version 15&#46;0&#44; for all statistical analyses&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">RESULTS</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">We examined the serological results from tests requested upon the first evaluation of 500 patients &#40;297 males and 203 females&#41; with diabetes mellitus &#40;95&#37; with type 2 DM&#41; referred for nephrological pathology analysis in nephrology external consultations&#46; The mean patient age was 61&#46;58&#43;13&#46;97 years &#40;range&#58; 15-87 years&#41;&#46; From a nephrological point of view&#44; 137 patients &#40;27&#46;4&#37;&#41; had an MDRD4 glomerular filtration rate &#40;GFR&#41; &#62;60ml&#47;min&#44; and the rest had an MDRD4 GFR&#60;60ml&#47;min &#40;mean&#58; 39&#46;17&#43;12&#46;99ml&#47;min&#41; &#40;57&#37; with stage 3 chronic renal failure &#91;CRF&#93;&#44; 14&#46;6&#37; with stage 4 CRF&#44; and 1&#37; with stage 5 CRF&#41;&#59; mean serum creatinine was 1&#46;56&#43;0&#46;67mg&#47;dl&#44; and mean proteinuria was 1&#46;20&#43;2&#46;13g&#47;24 hours&#46;</p><p class="elsevierStylePara">Seventeen patients were positive for anti-HCV&#44; but only 12 were positive in the confirmation test&#46; The 12 patients &#40;7 males and 5 females&#41; with positive anti-HCV and confirmation test results had a mean age of 60&#46;44&#43;15&#46;52 years&#59; only one patient had elevated transaminase levels&#44; 2 patients had signs of portal hypertension in ultrasound tests&#44; and only 2 patients received anti-viral treatment with negative results from tests taken later for HCV&#46; One patient was treated with interferon alpha and ribavirin&#44; and the other was treated with pegylated interferon and ribavirin&#46;</p><p class="elsevierStylePara">Positive FTA and RPR were observed in 5 patients &#40;3 males and 2 females&#59; mean age&#58; 61&#46;80&#43;10&#46;52 years&#41;&#46; All five patients received treatment&#46;</p><p class="elsevierStylePara">Two patients &#40;one male and one female&#41; had chronic hepatitis B&#44; 51 patients &#40;34 males and 17 females&#59; mean age&#58; 61&#46;70&#43;13&#46;26 years&#41; had resolved or cured hepatitis&#44; and 21 patients &#40;15 males and 16 females&#59; mean age&#58; 60&#46;20&#43;16&#46;58 years&#41; had been vaccinated&#46; The two patients with chronic hepatitis B had normal transaminase levels&#46;</p><p class="elsevierStylePara">One patient who disappeared from the follow-up programme had positive anti-HCV and HBsAg&#46; No patients had positive anti-HIV serology&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">In a recent study from the United States&#44; of 29 patients diagnosed with acute hepatitis B&#44; 25 were diabetic&#44;<span class="elsevierStyleSup">7</span> which led to the analysis of risk of infection by hepatitis B virus &#40;HBV&#41; among diabetic patients&#46; The authors found that&#44; in patients with no risk behaviours for HBV and aged 23-59 years&#44; diabetics were 1&#46;2 times more likely to be infected than those without diabetes&#46;<span class="elsevierStyleSup">7</span> On 25 October 2011&#44; the Hepatitis Vaccines Work Group of the Advisory Committee on Immunization Practices &#40;ACIP&#41; of the United States recommended that all patients with diabetes mellitus &#40;types 1 and 2&#41; between the ages of 19 and 59 years should receive the hepatitis B vaccine as soon as possible after being diagnosed with diabetes mellitus &#40;category A recommendation&#41;&#46; Given the fact that data regarding HBV infection in patients older than 60 years of age are still unclear&#44; the ACIP left the choice of whether or not to vaccinate these patients in the hands of the attending physician&#46; Approximately 15&#37; of patients with chronic HBV infection will develop cirrhosis or hepatocarcinoma&#46;<span class="elsevierStyleSup">8</span> In our study population&#44; 10&#46;6&#37; of patients had been in contact with HBV&#44; 0&#46;4&#37; became chronic carriers and the rest recovered&#46; No patients had cirrhosis or hepatocarcinoma&#46; Only 4&#46;2&#37; had received vaccines&#44; a very small percentage for an at-risk population such as diabetic patients&#46;</p><p class="elsevierStylePara">As regards HCV&#44; only 2&#46;4&#37; of patients studied over the 5-year period had positive hepatitis C antibodies&#46; Since our study did not examine annual prevalence or cumulative incidence&#44; our results would not be compared with the results from the general population or with results from chronic renal failure patients&#46; If we suppose that the number of new cases is the same every year&#44; we would obtain 0&#46;48&#37; of new patients per year&#46; We must point out that two &#40;16&#46;6&#37;&#41; of the patients with hepatitis C already had signs of cirrhosis or portal hypertension in the abdominal ultrasound&#46; The first observation that patients with cirrhosis and HCV infections had diabetes at a greater frequency than patients with cirrhosis of another aetiology was published in 1994&#44;<span class="elsevierStyleSup">9</span> and later studies also confirmed this finding&#46;<span class="elsevierStyleSup">10-12 </span>In this context&#44; elevated levels of glycaemia as hyperinsulinaemia and insulin resistance have been associated with increased fibrosis in chronic hepatitis C&#59; in addition&#44; the progression of hepatitis C is faster in diabetic patients<span class="elsevierStyleSup">&#46;13-16</span></p><p class="elsevierStylePara">Finally&#44; only 4 of the 500 patients studied over the 5-year period had positive serology results for syphilis&#46; Syphilis must be included in the differential diagnosis for diabetic patients with diabetic nephropathy and with distal and symmetrical motor and sensory deficits&#46;<span class="elsevierStyleSup">17</span> From a cardiovascular point of view&#44; 10&#37; of patients with syphilis can develop aortic insufficiency&#44; coronary ostial stenosis&#44; or aortic aneurysms&#46;<span class="elsevierStyleSup">18</span> From a nephrological point of view&#44; nephropathy can arise both in congenital syphilis and secondary syphilis&#46; The most common form is nephrotic syndrome secondary to membranous glomerulonephritis with subepithelial IgG and complement deposits&#44; having previously demonstrated the presence of both treponemal antigen and anti-treponemal antibodies in glomerular lesions&#46;<span class="elsevierStyleSup">19&#44;20</span> Tubulo-interstitial nephritis is also common&#44; and treatment with penicillin leads to a rapid resolution of the nephropathy&#46;</p><p class="elsevierStylePara">In summary&#44; the primary findings of this study are that 0&#46;4&#37; of patients had chronic hepatitis B&#44; 10&#46;2&#37; had been cured of hepatitis B&#44; 4&#46;2&#37; had received the hepatitis B vaccine&#44; 2&#46;4&#37; had antibodies against hepatitis C&#44; and 0&#46;8&#37; had positive serology tests for syphilis&#46; As such&#44; while the frequency of hepatitis C is similar to that of the general population&#44; the percentage of patients with antibodies against HBV is greater than in the general population&#46; The two patients with cirrhosis and portal hypertension had hepatitis C&#46;</p><p class="elsevierStylePara">In the medical literature reviewed&#44; we have not found any studies that examine the microbiological serology of diabetic patients with nephrological pathologies that are attended in external consultations&#46; As such&#44; and despite the major methodological limitations implied&#44; this would be the first study in which these components are studied&#46; Diabetic nephropathy is an ever-increasing preoccupation for nephrologists&#44; and well-designed studies that aid in the in-depth analysis of these patients could be very helpful&#46; It would also be interesting to evaluate the response of patients with diabetic nephropathy to antiviral treatment&#46;</p><p class="elsevierStylePara">To conclude&#44; diabetic patients referred to nephrology external consultations in the southern region of Grand Canary Island have a similar percentage of individuals with HCV antibodies as the general population&#44; but the percentage of individuals with HBV antibodies is greater than in the general population&#46; Given that only two patients had HBsAg&#44; we must still examine whether this would justify the vaccination of all diabetic patients referred to our practice&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The authors state that they have no potential conflicts of interest related to the contents of this article&#46;</p>"
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        "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Antecedentes&#58;</span>&#160;En Espa&#241;a hay datos sobre prevalencia e incidencia de serolog&#237;as microbiol&#243;gicas positivas tanto en la poblaci&#243;n general como en pacientes en hemodi&#225;lisis&#46; Sin embargo&#44; se conocen pocos datos sobre los pacientes con diabetes&#160;atendidos en consulta externa de Nefrolog&#237;a&#46; <span class="elsevierStyleBold">Objetivo&#58;</span> Valorar el porcentaje de pacientes con serolog&#237;as positivas para hepatitis B y C&#44; virus de inmunodeficiencia humana &#40;VIH&#41; y s&#237;filis en la valoraci&#243;n inicial&#160;de los pacientes remitidos para estudio a la consulta externa de nefropat&#237;a diab&#233;tica&#46; <span class="elsevierStyleBold">Pacientes y m&#233;todos&#58;</span>&#160;Estudio retrospectivo de las serolog&#237;as solicitadas con el diagn&#243;stico de nefropat&#237;a diab&#233;tica con origen en consultas externas de 500 pacientes valorados durante 5 a&#241;os a los que se les hab&#237;a solicitado serolog&#237;as de la hepatitis B&#44; C&#44; VIH y s&#237;filis&#46; <span class="elsevierStyleBold">Resultados&#58;</span>&#160;Respecto al virus de la hepatitis B&#44; el 0&#44;4 &#37; de los pacientes ten&#237;an hepatitis B cr&#243;nica&#44; el 10&#44;2 &#37; hab&#237;a pasado la hepatitis y estaban curados y el 4&#44;2 &#37; hab&#237;a recibido la vacuna de la hepatitis B&#46; En cuanto a la hepatitis C&#44; el 2&#44;4 &#37; de los pacientes estudiados ten&#237;an anticuerpos frente hepatitis C&#46; Respecto a la s&#237;filis&#44; el 0&#44;8 &#37; de los pacientes ten&#237;an serolog&#237;as positivas&#46; Ning&#250;n paciente present&#243; serolog&#237;as positivas para VIH&#46; <span class="elsevierStyleBold">Conclusiones&#58;</span>&#160;Si bien con grandes limitaciones metodol&#243;gicas&#44; este ser&#237;a el primer estudio donde se revisan las serolog&#237;as microbiol&#243;gicas de pacientes con nefropat&#237;a diab&#233;tica atendidos en consulta externa&#46;</p>"
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        "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Introduction&#58;</span> Information is available regarding the prevalence and incidence of positive microbiological serology results&#160;both in the general population and in patients on haemodialysis in Spain&#46; Nevertheless&#44; little information is known regarding patients with diabetes attended in external nephrology consultations&#46; <span class="elsevierStyleBold">Objective&#58; </span>To evaluate the percentage of patients with positive serology results for hepatitis B and C&#44; Human Immunodeficiency Virus &#40;HIV&#41;&#44; and syphilis in the initial assessment of patients referred to diabetic nephropathy external consultations&#46; <span class="elsevierStyleBold">Patients and method&#58;</span> Retrospective study of 500 patients assessed over the course of 5 years with the diagnosis of diabetic nephropathy originating in external consultations and for which hepatitis B&#44; C&#44; HIV&#44; and syphilis serology had been requested&#46; <span class="elsevierStyleBold">Results&#58;</span> With regard to hepatitis B virus&#44; 0&#46;4&#37; of patients had chronic hepatitis B&#44; 10&#46;2&#37; had overcome the hepatitis and were in recovery&#44; and 4&#46;2&#37; had received the hepatitis B vaccine&#46; As for hepatitis C&#44; 2&#46;4&#37; of the patients studied had antibodies against hepatitis C&#46; With regard to syphilis&#44; 0&#46;8&#37; of patients had positive serological results&#46; No patients had positive HIV serology results&#46; <span class="elsevierStyleBold">Conclusions&#58;</span> Despite major methodological limitations&#44; this would be the first study to evaluate the microbiological serology of diabetic nephropathy patients treated in external consultations&#46;</p>"
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Serology for Hepatitis B and C, HIV and syphilis in the initial evaluation of diabetes patients referred for an external Nephrology consultation
Serologías B, C, VIH y sífilis en la primera valoración de pacientes con diabetes remitidos a consulta externa de Nefrología
Noemí Esparza Martína, Noemí Esparza-Martínb, Araceli Hernández Betancorc, Araceli Hernández-Betancord, Santiago Suria Gonzáleza, Santiago Suria-Gonzálezb, Fátima Batista Garcíaa, Fátima Batista-Garcíab, Pablo Braillard Pocarda, Pablo Braillard-Pocardb, Ana Yurena Sánchez Santanaa, Ana Y. Sánchez-Santanab, Rita Guerra Rodrigueza, Rita Guerra-Rodríguezb, Ana Ramírez-Pugab, María Dolores Checa Andrésa, M. Dolores Checa-Andrésb
a Nefrología, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria Las Palmas, Spain,
b Servicio de Nefrología, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria,
c Microbiología, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria Las Palmas, Spain,
d Servicio de Microbiología, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria,
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    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">INTRODUCTION</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">In the general population in Spain&#44; the prevalence of hepatitis C virus &#40;HCV&#41; antibodies ranges between 1&#46;6&#37; and 2&#46;6&#37;&#44;<span class="elsevierStyleSup">1</span> with rates of 2&#37;-7&#37; reported for hepatitis B virus &#40;HBV&#41;&#46;<span class="elsevierStyleSup">2</span> The incidence rate of syphilis in 2010 was 6&#46;39&#47;100&#160;000 inhabitants&#44; and the Canary Islands had the highest syphilis rate in Spain &#40;12&#46;71&#47;100&#160;000&#41;&#46;<span class="elsevierStyleSup">3</span></p><p class="elsevierStylePara">The prevalence of chronic HCV infection in patients with stage 5 chronic kidney disease is higher than in the general population&#46; In patients on haemodialysis&#44; the prevalence rate is estimated at 13&#37;&#44; with a wide variability among geographic regions &#40;1&#37;-70&#37;&#41;<span class="elsevierStyleSup">4</span> and among dialysis units within the same country&#46; In Spain&#44; the prevalence of HCV infection in patients on haemodialysis in 1997-2001 was estimated at 22&#37;&#46;<span class="elsevierStyleSup">5</span></p><p class="elsevierStylePara">In Greece&#44; 5&#37; of patients on haemodialysis are positive for hepatitis B surface antigen&#46;<span class="elsevierStyleSup">6</span> In addition&#44; a recent publication showed that all diabetic patients between the ages of 19 and 59 years should receive the hepatitis B vaccine&#44; leaving the vaccination of patients older than 60 years of age up to the criteria of the attending physician&#46;<span class="elsevierStyleSup">7</span></p><p class="elsevierStylePara">In a review of the relevant medical literature&#44; we have found no information regarding the incidence of syphilis in chronic renal failure patients&#46;</p><p class="elsevierStylePara">With this in mind&#44; the objective of our study was to evaluate the percentage of patients with positive serological tests for hepatitis B and C&#44; human immunodeficiency virus &#40;HIV&#41;&#44; and syphilis in the initial assessment of patients referred to external consultation for diabetic nephropathy&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">PATIENTS AND METHOD</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Ours was a retrospective study of the serological tests requested for diabetic patients referred for an evaluation for diabetic nephropathy upon their first visit to nephrological external consultations &#40;southern region of Grand Canary Island&#41;&#46; We compiled the results of serological analyses supplied by the microbiology department at our hospital &#40;started 5 July 2007&#41; until the study date &#40;10 November 2011&#41;&#46; Serology tests had been requested for a total of 500 patients &#40;297 males and 203 females&#41; within this period&#46; However&#44; our study did not include all patients evaluated for the first time in external consultations for diabetic nephropathy during this period&#44; only those requested in the name of the attending physician&#44; since many requests are made by residents on rotation in various medical specialties&#46; We also compiled biochemical results from urine and blood tests taken on the same date as the serology tests for each patient&#46; For hepatitis B&#44; we examined the results for hepatitis B surface antigen &#40;HBsAg&#41;&#44; total antibodies against core antigen &#40;anti-HBc&#41;&#44; IgM antibodies against core antigen of the hepatitis B virus &#40;anti-HBcIgM&#41;&#44; &#8216;e&#8217; antigen &#40;HBeAg&#41;&#44; antibodies against e antigen &#40;anti-HBe&#41;&#44; and antibodies against hepatitis B surface antigen &#40;anti-HBs&#41;&#46; In cases in which the value for HBsAg was very low and we had to rule out a false positive&#44; we performed a confirmation test for surface antigen &#40;neutralisation&#41;&#46; For hepatitis C&#44; we examined levels of hepatitis C antibodies &#40;anti-HCV&#41;&#44; and if the test was positive&#44; we performed a confirmation test using a LIA<span class="elsevierStyleSup">&#174;</span> line immunoassay test in order to rule out a false positive&#46; For HIV&#44; some patients were only tested for antibodies &#40;anti-HIV&#41;&#44; and more recent patients were tested for both anti-HIV and p24 antigen&#44; which allows for early detection of cases in which antibodies are still undetectable&#46; In accordance with laboratory protocol&#44; in cases of positive test results for anti-HIV&#44; we performed a confirmation test using LIA<span class="elsevierStyleSup">&#174;</span> line immunoassay&#46; For syphilis&#44; a rapid plasma reagin test &#40;RPR&#41;&#44; was performed&#44; as well as a fluorescent treponemal antibody test &#40;FTA&#41;&#59; to rule out false positives&#44; a confirmation test using LIA<span class="elsevierStyleSup">&#174;</span> line immunoassays was performed&#46;</p><p class="elsevierStylePara">Patients were subdivided into three categories based on hepatitis B serology results&#58; chronic hepatitis B &#40;HBsAg and anti-HBc positive&#44; with or without HBeAg&#41;&#44; resolved or cured hepatitis B &#40;HBsAg negative and anti-HBc positive&#41;&#44; and vaccinated against hepatitis B &#40;anti-HBs positive with seronegativity for HBsAg and anti-HBc&#41;&#46;</p><p class="elsevierStylePara">We reviewed the clinical histories of all patients with positive serology results &#40;transaminase&#44; whether or not treatment was given and response to treatment&#44; and ultrasound with or without signs of portal hypertension&#41;&#46;</p><p class="elsevierStylePara">We used SPSS statistical software&#44; version 15&#46;0&#44; for all statistical analyses&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">RESULTS</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">We examined the serological results from tests requested upon the first evaluation of 500 patients &#40;297 males and 203 females&#41; with diabetes mellitus &#40;95&#37; with type 2 DM&#41; referred for nephrological pathology analysis in nephrology external consultations&#46; The mean patient age was 61&#46;58&#43;13&#46;97 years &#40;range&#58; 15-87 years&#41;&#46; From a nephrological point of view&#44; 137 patients &#40;27&#46;4&#37;&#41; had an MDRD4 glomerular filtration rate &#40;GFR&#41; &#62;60ml&#47;min&#44; and the rest had an MDRD4 GFR&#60;60ml&#47;min &#40;mean&#58; 39&#46;17&#43;12&#46;99ml&#47;min&#41; &#40;57&#37; with stage 3 chronic renal failure &#91;CRF&#93;&#44; 14&#46;6&#37; with stage 4 CRF&#44; and 1&#37; with stage 5 CRF&#41;&#59; mean serum creatinine was 1&#46;56&#43;0&#46;67mg&#47;dl&#44; and mean proteinuria was 1&#46;20&#43;2&#46;13g&#47;24 hours&#46;</p><p class="elsevierStylePara">Seventeen patients were positive for anti-HCV&#44; but only 12 were positive in the confirmation test&#46; The 12 patients &#40;7 males and 5 females&#41; with positive anti-HCV and confirmation test results had a mean age of 60&#46;44&#43;15&#46;52 years&#59; only one patient had elevated transaminase levels&#44; 2 patients had signs of portal hypertension in ultrasound tests&#44; and only 2 patients received anti-viral treatment with negative results from tests taken later for HCV&#46; One patient was treated with interferon alpha and ribavirin&#44; and the other was treated with pegylated interferon and ribavirin&#46;</p><p class="elsevierStylePara">Positive FTA and RPR were observed in 5 patients &#40;3 males and 2 females&#59; mean age&#58; 61&#46;80&#43;10&#46;52 years&#41;&#46; All five patients received treatment&#46;</p><p class="elsevierStylePara">Two patients &#40;one male and one female&#41; had chronic hepatitis B&#44; 51 patients &#40;34 males and 17 females&#59; mean age&#58; 61&#46;70&#43;13&#46;26 years&#41; had resolved or cured hepatitis&#44; and 21 patients &#40;15 males and 16 females&#59; mean age&#58; 60&#46;20&#43;16&#46;58 years&#41; had been vaccinated&#46; The two patients with chronic hepatitis B had normal transaminase levels&#46;</p><p class="elsevierStylePara">One patient who disappeared from the follow-up programme had positive anti-HCV and HBsAg&#46; No patients had positive anti-HIV serology&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">In a recent study from the United States&#44; of 29 patients diagnosed with acute hepatitis B&#44; 25 were diabetic&#44;<span class="elsevierStyleSup">7</span> which led to the analysis of risk of infection by hepatitis B virus &#40;HBV&#41; among diabetic patients&#46; The authors found that&#44; in patients with no risk behaviours for HBV and aged 23-59 years&#44; diabetics were 1&#46;2 times more likely to be infected than those without diabetes&#46;<span class="elsevierStyleSup">7</span> On 25 October 2011&#44; the Hepatitis Vaccines Work Group of the Advisory Committee on Immunization Practices &#40;ACIP&#41; of the United States recommended that all patients with diabetes mellitus &#40;types 1 and 2&#41; between the ages of 19 and 59 years should receive the hepatitis B vaccine as soon as possible after being diagnosed with diabetes mellitus &#40;category A recommendation&#41;&#46; Given the fact that data regarding HBV infection in patients older than 60 years of age are still unclear&#44; the ACIP left the choice of whether or not to vaccinate these patients in the hands of the attending physician&#46; Approximately 15&#37; of patients with chronic HBV infection will develop cirrhosis or hepatocarcinoma&#46;<span class="elsevierStyleSup">8</span> In our study population&#44; 10&#46;6&#37; of patients had been in contact with HBV&#44; 0&#46;4&#37; became chronic carriers and the rest recovered&#46; No patients had cirrhosis or hepatocarcinoma&#46; Only 4&#46;2&#37; had received vaccines&#44; a very small percentage for an at-risk population such as diabetic patients&#46;</p><p class="elsevierStylePara">As regards HCV&#44; only 2&#46;4&#37; of patients studied over the 5-year period had positive hepatitis C antibodies&#46; Since our study did not examine annual prevalence or cumulative incidence&#44; our results would not be compared with the results from the general population or with results from chronic renal failure patients&#46; If we suppose that the number of new cases is the same every year&#44; we would obtain 0&#46;48&#37; of new patients per year&#46; We must point out that two &#40;16&#46;6&#37;&#41; of the patients with hepatitis C already had signs of cirrhosis or portal hypertension in the abdominal ultrasound&#46; The first observation that patients with cirrhosis and HCV infections had diabetes at a greater frequency than patients with cirrhosis of another aetiology was published in 1994&#44;<span class="elsevierStyleSup">9</span> and later studies also confirmed this finding&#46;<span class="elsevierStyleSup">10-12 </span>In this context&#44; elevated levels of glycaemia as hyperinsulinaemia and insulin resistance have been associated with increased fibrosis in chronic hepatitis C&#59; in addition&#44; the progression of hepatitis C is faster in diabetic patients<span class="elsevierStyleSup">&#46;13-16</span></p><p class="elsevierStylePara">Finally&#44; only 4 of the 500 patients studied over the 5-year period had positive serology results for syphilis&#46; Syphilis must be included in the differential diagnosis for diabetic patients with diabetic nephropathy and with distal and symmetrical motor and sensory deficits&#46;<span class="elsevierStyleSup">17</span> From a cardiovascular point of view&#44; 10&#37; of patients with syphilis can develop aortic insufficiency&#44; coronary ostial stenosis&#44; or aortic aneurysms&#46;<span class="elsevierStyleSup">18</span> From a nephrological point of view&#44; nephropathy can arise both in congenital syphilis and secondary syphilis&#46; The most common form is nephrotic syndrome secondary to membranous glomerulonephritis with subepithelial IgG and complement deposits&#44; having previously demonstrated the presence of both treponemal antigen and anti-treponemal antibodies in glomerular lesions&#46;<span class="elsevierStyleSup">19&#44;20</span> Tubulo-interstitial nephritis is also common&#44; and treatment with penicillin leads to a rapid resolution of the nephropathy&#46;</p><p class="elsevierStylePara">In summary&#44; the primary findings of this study are that 0&#46;4&#37; of patients had chronic hepatitis B&#44; 10&#46;2&#37; had been cured of hepatitis B&#44; 4&#46;2&#37; had received the hepatitis B vaccine&#44; 2&#46;4&#37; had antibodies against hepatitis C&#44; and 0&#46;8&#37; had positive serology tests for syphilis&#46; As such&#44; while the frequency of hepatitis C is similar to that of the general population&#44; the percentage of patients with antibodies against HBV is greater than in the general population&#46; The two patients with cirrhosis and portal hypertension had hepatitis C&#46;</p><p class="elsevierStylePara">In the medical literature reviewed&#44; we have not found any studies that examine the microbiological serology of diabetic patients with nephrological pathologies that are attended in external consultations&#46; As such&#44; and despite the major methodological limitations implied&#44; this would be the first study in which these components are studied&#46; Diabetic nephropathy is an ever-increasing preoccupation for nephrologists&#44; and well-designed studies that aid in the in-depth analysis of these patients could be very helpful&#46; It would also be interesting to evaluate the response of patients with diabetic nephropathy to antiviral treatment&#46;</p><p class="elsevierStylePara">To conclude&#44; diabetic patients referred to nephrology external consultations in the southern region of Grand Canary Island have a similar percentage of individuals with HCV antibodies as the general population&#44; but the percentage of individuals with HBV antibodies is greater than in the general population&#46; Given that only two patients had HBsAg&#44; we must still examine whether this would justify the vaccination of all diabetic patients referred to our practice&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The authors state that they have no potential conflicts of interest related to the contents of this article&#46;</p>"
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        "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Antecedentes&#58;</span>&#160;En Espa&#241;a hay datos sobre prevalencia e incidencia de serolog&#237;as microbiol&#243;gicas positivas tanto en la poblaci&#243;n general como en pacientes en hemodi&#225;lisis&#46; Sin embargo&#44; se conocen pocos datos sobre los pacientes con diabetes&#160;atendidos en consulta externa de Nefrolog&#237;a&#46; <span class="elsevierStyleBold">Objetivo&#58;</span> Valorar el porcentaje de pacientes con serolog&#237;as positivas para hepatitis B y C&#44; virus de inmunodeficiencia humana &#40;VIH&#41; y s&#237;filis en la valoraci&#243;n inicial&#160;de los pacientes remitidos para estudio a la consulta externa de nefropat&#237;a diab&#233;tica&#46; <span class="elsevierStyleBold">Pacientes y m&#233;todos&#58;</span>&#160;Estudio retrospectivo de las serolog&#237;as solicitadas con el diagn&#243;stico de nefropat&#237;a diab&#233;tica con origen en consultas externas de 500 pacientes valorados durante 5 a&#241;os a los que se les hab&#237;a solicitado serolog&#237;as de la hepatitis B&#44; C&#44; VIH y s&#237;filis&#46; <span class="elsevierStyleBold">Resultados&#58;</span>&#160;Respecto al virus de la hepatitis B&#44; el 0&#44;4 &#37; de los pacientes ten&#237;an hepatitis B cr&#243;nica&#44; el 10&#44;2 &#37; hab&#237;a pasado la hepatitis y estaban curados y el 4&#44;2 &#37; hab&#237;a recibido la vacuna de la hepatitis B&#46; En cuanto a la hepatitis C&#44; el 2&#44;4 &#37; de los pacientes estudiados ten&#237;an anticuerpos frente hepatitis C&#46; Respecto a la s&#237;filis&#44; el 0&#44;8 &#37; de los pacientes ten&#237;an serolog&#237;as positivas&#46; Ning&#250;n paciente present&#243; serolog&#237;as positivas para VIH&#46; <span class="elsevierStyleBold">Conclusiones&#58;</span>&#160;Si bien con grandes limitaciones metodol&#243;gicas&#44; este ser&#237;a el primer estudio donde se revisan las serolog&#237;as microbiol&#243;gicas de pacientes con nefropat&#237;a diab&#233;tica atendidos en consulta externa&#46;</p>"
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        "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Introduction&#58;</span> Information is available regarding the prevalence and incidence of positive microbiological serology results&#160;both in the general population and in patients on haemodialysis in Spain&#46; Nevertheless&#44; little information is known regarding patients with diabetes attended in external nephrology consultations&#46; <span class="elsevierStyleBold">Objective&#58; </span>To evaluate the percentage of patients with positive serology results for hepatitis B and C&#44; Human Immunodeficiency Virus &#40;HIV&#41;&#44; and syphilis in the initial assessment of patients referred to diabetic nephropathy external consultations&#46; <span class="elsevierStyleBold">Patients and method&#58;</span> Retrospective study of 500 patients assessed over the course of 5 years with the diagnosis of diabetic nephropathy originating in external consultations and for which hepatitis B&#44; C&#44; HIV&#44; and syphilis serology had been requested&#46; <span class="elsevierStyleBold">Results&#58;</span> With regard to hepatitis B virus&#44; 0&#46;4&#37; of patients had chronic hepatitis B&#44; 10&#46;2&#37; had overcome the hepatitis and were in recovery&#44; and 4&#46;2&#37; had received the hepatitis B vaccine&#46; As for hepatitis C&#44; 2&#46;4&#37; of the patients studied had antibodies against hepatitis C&#46; With regard to syphilis&#44; 0&#46;8&#37; of patients had positive serological results&#46; No patients had positive HIV serology results&#46; <span class="elsevierStyleBold">Conclusions&#58;</span> Despite major methodological limitations&#44; this would be the first study to evaluate the microbiological serology of diabetic nephropathy patients treated in external consultations&#46;</p>"
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ISSN: 20132514
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