NPY Levels In Type 1 Diabetic Men of Different Duration.

Background: The aim of the present study was to evaluate whether the different duration of type 1 diabetes mellitus influences basal NPY secretion. Design: The NPY concentrations were measured in sixty-eight men with insulin-dependent diabetes mellitus (IDDM) (duration: group 1 (n.21) <5 years (range 2-4 years); group 2 (n.24) >5 years and <10 years (range: 6-9 years); group 3 (n.29) >10 years (range: 11-14 years)) and in age matched normal control subjects (n. 30). Results: The NPY levels were significantly lower in group 3 than in group 2 and 1 and in the control group, in group 2 than in group 1 and in the control group and in group 1 than control group. Conclusion: These results support the view that the duration of diabetes may have a modulatory role in the decreased basal NPY secretion observed in diabetics

Inappropriateness in biliary stenting

Starting from a real case of a 69-year old patient affected by cholangiocarcinoma, we intend to discuss the accuracy and appropriateness of the diagnostic and therapeutic procedures adopted. This case shows in particular that a more accurate preoperative staging could probably avoid the patient unnecessary laparotomy. According to the indications in the medical literature, this patient could possibly benefit from chemotherapy, but a chemoembolization of liver metastases was performed. However in the literature no available evidence suggests that this treatment would be beneficial in this kind of clinical picture. Eventually, when the disease was already at an advanced stage and worsened due to a necrosis of the left hepatic lobe and a cholangitic infection, a repositioning of the stent on the stent was performed, despite in the literature the life expectancy cut-off for this procedure is at least 6 months. We also discuss the communication between the physician, the patient and the family, which was probably based on overly optimistic and unrealistic expectations. This led to a number of surgical procedures, which were not certainly helpful and indeed were probably even harmful for this patient. In addition, these procedures caused unnecessary costs borne by the healthcare system. In conclusion, we advocate that discussion and self-assessment must be always promoted, so that the healthcare professionals can review the process and the outcome of their treatment as well as their behavior to understand if it could have been more appropriate to offer actual benefits to the patients in terms of better quality of life and longer life expectancy

Biomarkers for sepsis: past, present and future

Sepsis is a complication of severe infection associated with high mortality and open diagnostic issues. Treatment strategies are currently limited and essentially based on prompt recognition, aggressive supportive care and early antibiotic treatment. In the last years, extensive antibiotic use has led to selection, propagation and maintenance of drug-resistant microorganisms. In this context, several biomarkers have been proposed for early identification, etiological definition, risk stratification and improving antibiotic stewardship in septic patient care. Among these molecules, only a few have been translated into clinical practice. In this review, we provided an updated overview of established and developing biomarkers for sepsis, focusing our attention on their pathophysiological profile, advantages, limitations, and appropriate evidence-based use in the management of septic patients

Heart failure in real world

The heart failure (HF) is one of the greatest problems of public health with increasing epidemiological importance. In the present study we analyzed a population of 299 patients, consecutively admitted to hospital, whose diagnosis of HF was verified retrospectively. In our analysis we considered underlying heart diseases, comorbidities, ejection fraction, presence of atrial fibrillation and pleural effusion, values of NT pro-BNP and causes of destabilization precipitating HF. The mean age of our population was 81 years. Patients with preserved systolic function were 145 (61% of the total, 59 male and 86 female). 166 patients (69% of the total) had hypertensive heart disease and 211 had hypertension (88% of the total). Patients with pleural effusion were 108 (46% of total). In the total population 102 patients (43%) had from 3 to 5 comorbidities, 169 patients (71%) had at least 2 comorbidities and only 4 patients (1.7%) had no comorbidities. The collected data highlight the complexity of patients with HF, often due to advanced age and a high number of comorbidities

Marked sinus bradycardia and QT prolongation in a diabetic patient with severe hypoglicemia.

We report an uncommon case of an insulin-treated patient, presenting severe hypoglycemia, coma, marked sinus bradycardia and QT prolongation. Intravenous administration of glucose and atropine awaked the patient and increased heart rate but did not affect QT prolongation. Basal and exercise electrocardiogram excluded primary diseases associated with QT prolongation. Pathophysiologic aspects of electrocardiographic and clinical findings occurring in the hypoglycemic patients are briefly disussed