The epidemic of type 2 diabetes in the United States prompted us to explore the association between diabetes and tuberculosis (TB) on the South Texas-Mexico border, in a large population of mostly non-hospitalized TB patients. We examined 6 years of retrospective data from all TB patients (n=5049) in South Texas and northeastern Mexico and found diabetes self-reported by 27.8% of Texan and 17.8% of Mexican TB patients, significantly exceeding national self-reported diabetes rates for both countries. Diabetes comorbidity substantially exceeded that of HIV/AIDS. Patients with TB and diabetes were older, more likely to have haemoptysis, pulmonary cavitations, be smear positive at diagnosis, and remain positive at the end of the first (Texas) or second (Mexico) month of treatment. The impact of type 2 diabetes on TB is underappreciated, and in the light of its epidemic status in many countries, it should be actively considered by TB control programmes, particularly in older patients.

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Background Cryoglobulinemic vasculitis (Vcrio) is characterized by the presence of circulating cryoglobulins usually affecting small blood vessel. The Nomenclature of Chapel Hill 1993 (A&R 1994;37:187) considered all VCrio generically. However, VCrio may be idiopathic (essential) or associated with chronic infections, mainly due to hepatitis C virus (HCV), autoimmune diseases and hematological malignancies. The new Nomenclature of Chapel Hill 2012 (A&R 2013:65:1) considered as Vcrio only the essential, and the remaining cases as Vcrio associated to other processes. Objectives Our aim was to study the frequency and characteristics of Vcrio according to this new classification in a defined population. Methods Study of a series of Vcrio from a universitary hospital. Circulating cryoglobulins (cryocrit>1%) and vasculitic involvement of a target organ, especially skin, peripheral nerve and/or kidney was required to make a diagnosis. For this purpose we used the criteria mentioned above (Chapel Hill-2012). According to them, VCrio were divided into primary and associated with other processes. A comparative study between both groups was performed. Results We studied 34 patients (15 men/19 women) with a mean±SD age of 53±15 years (range, 27-81). The essential Vcrio was observed in 12 cases. In the remaining cases it was associated with one or more of the following: a) HCV (15 cases), b) HBV (2 cases), c) autoimmune disease (6 cases; 4 Sjögren´s syndrome, 1 RA, 1 sarcoidosis, 1 SLE, 1 primary billiary cirrhosis) and d)hematological disorders (4 cases, 2 Hodgkin lymphomas, 1 NHL and 1 MALT lymphoma). The comparative study between primary Vcrio versus secondary (expressed always in this order) showed that the clinical vasculitic manifestations were similar in both groups: cutaneous (92% vs 86%, p=0.6), joint (75% vs 55%, p=0.2), kidney (33% vs 41%, p=0.6), peripheral neuropathy (25% vs 36%, p=0.5), Raynaud’s phenomenon (17% vs 14%, p=0.8), and digestive (8% vs 18%, p=0.4). The main laboratory findings were elevated ESR (75% vs 95%, p=0.1), leukocytosis (8% vs 5%, p=0.6), anemia (17% vs 50%, p=0.05). Immunological tests were determined in 29 cases being similar in both groups; positive Rheumatoid Factor (82% vs 83%, p=0.9) and decreased C3 and/or C4 (64% vs 56%, p=0.6). Positive Antinuclear Antibodies were more frequently observed in secondary Vcrio (0% vs 35%, p=0.02) and cryocrit in primary VCrio (25.5% vs 3%, p=0.02). Comparative study of treatment in primary Vcrio vs secondary was: a)NSAIDs (67% vs 20%, p=0.01), b)steroids (50% vs 71%, p=0.2), c)cytotoxic (40% vs 48%, p=0.7) and d)plasmapheresis (0% vs 18%, p=0.1). In 13.3% of patients with HCV-associated Vcrio combined antiviral therapy was used (interferon and ribavirin). After a median (IQR) of follow-up of 42 (8-99) months, relapses were observed in 45% vs 67%, (p=0.3) and complete recovery in 42% vs 13%,(p=0.9). Conclusions Overall, most clinical and laboratory manifestations related to vasculitis in the setting of both primary VCrio and that associated-to ...