Glycogenic hepatopathy associated with type 1 diabetes mellitus as a cause of recurrent liver damage

Aminotransferase elevation is a frequent cause of consultation for the Hepatologist, in both the outpatient and inpatient settings, but identifying the origin of these biochemical alterations may be challenging. Here we report a case where acute elevation of aminotransferases, associated with abdominal symptoms, was the cause of two hospitalizations in a short period of time. As the patient suffered from type 1 diabetes, celiac disease, and autoimmune thyroiditis, several potential causes of damage could be hypothesized, including celiac hepatitis, fatty liver, and autoimmune hepatitis. A liver biopsy performed in the occasion of the second hospitalization allowed to rule out autoimmune hepatitis and celiac hepatitis, showing mild signs of fatty infiltration. Staining with periodic acid-Schiff with or without diastase showed a marked accumulation of glycogen, indicating the presence of a glycogenic hepatopathy associated with poorly controlled type 1 diabetes. This condition may be a cause of liver damage in patients with type 1 and occasionally type 2 diabetes, but its occurrence is often overlooked. This case report illustrates the fact that glycogenic hepatopathy may relapse, and prompts the clinician to take into account this condition in the differential diagnosis of causes of liver injury

Passive Strategies for Building Retrofitting: Performances Analysis and Incentive Policies for the Iranian Scenario

A large amount of the Iranian energy demand is related to the building sector, mainly due to its obsolescence. In this paper, a second-skin system has been implemented as a retrofit action for an office building, evaluating the effect of a tensile material as second-skin in terms of primary energy saving, carbon dioxide equivalent emissions, and simple payback period. The analysis was carried out through numerical simulations across a whole year and for four Iranian cities (Tabriz, Teheran, Yazd, and Bandar Abbas) in four different climates (cold, temperate, hot-dry, and hot-wet), and with the building aligned at either north-south or east-west. Moreover, an economic analysis was carried out suggesting different incentive policies to promote building energy refurbishment. The simulation results highlighted a favorable orientation for buildings in Iran, suggesting a guideline for new constructions. Indeed, the best results were achieved for an east-west orientation of the building (up to a primary energy saving of 13.6% and reduction of carbon dioxide equivalent emissions of 45.5 MgCO2,eq, in Yazd), with a decrease of the annual specific total (cooling and thermal) energy demand of 37.9 kWh/m2 /year. The simple payback period values were also lower in the east-west orientation than the north-south one

Timing considerations on the shear bond strength of orthodontic brackets after topical fluoride varnish applications

OBJECTIVES: To assess the best temporal association between the application of a fluoride varnish on enamel and bonding procedures. MATERIALS AND METHODS: Eighty mandibular bovine incisors were used. Teeth were divided into 4 groups (20 per group); Groups 1-3 were treated with fluoride varnish (Fluor Protector, Ivoclar Vivadent, Schaan, Liechtenstein), and Group 4 served as control with no pretreatment. Tooth were stored in deionized water (37\ub0C) and subjected to thermal cycling for 400 (Group 1), 800 (Group 2), and 2500 (Group 3) cycles corresponding, respectively, to 15, 30, and 90 days in order to simulate the three different timing of bracket bonding. Shear bond strength (SBS) was measured using an Instron Universal Testing machine. Tooth surfaces were examined under a stereomicroscope at 10 7 magnification to assess the amount of adhesive remnant index (ARI). One-way analysis of variance (ANOVA) and Tukey's honestly significant difference post-hoc test were used for the comparison of SBS values between groups (P < 0.05). The Chi-square test was used to examine differences among ARI scores. (P < 0.05). RESULTS: One-way ANOVA and Tukey post-hoc test showed that the SBS of different groups were significantly different and was impacted by different timing of bonding (P < 0.05). The main differences were between the control group (17.02 \ub1 6.38 MPa) and Group 1 (6.93 \ub1 4.3 MPa). The ARI scores showed that there were no significant differences between the four tested groups. CONCLUSIONS: The SBS of the brackets bonded 15 days after the application of the fluoride was set back to an optimal value

Sleep quality and sex-related factors in adult patients with immune-mediated diabetes: a large cross-sectional study

AimTo analyze sleep quality and its relationships with clinical and biochemical features in a large cohort of adults with autoimmune diabetes.MethodsWe administered to 553 patients with autoimmune diabetes the questionnaires: Pittsburgh Sleep Quality Index (PSQI), diabetes distress scale, diabetes-related quality of life and diabetes treatment satisfaction questionnaire. We excluded patients with missing HbA1c +/- 4 months from PSQI administration or incorrect PSQI compilation (n = 110).ResultsAltered sleep quality was recorded in 142/443 subjects (32%), insufficient total sleep time in 177/443 (40%). The altered sleep quality group had higher HbA1c (median 56 mmol/mol [interquartile range-IQR 49-62] vs 59 [IQR 52-68]; P < 0.001), higher average HbA1c in the previous 36 months (59 mmol/mol [IQR 54-68] vs 56 [IQR 51-62]; P < 0.001), and more individuals with HbA1c > 53 mmol/mol (74.6% vs 62.8%; P = 0.014). Diabetes duration (P = 0.63), type of insulin delivery (P = 0.48) and glucose monitoring (P = 0.35) were uninfluential. Patients with altered sleep quality showed higher prevalence of autoimmune (42 vs 28%; P = 0.005) and mental diseases (12 vs 4%; P = 0.002); there were greater emotional distress, and lower quality of life and treatment satisfaction (P < 0.001 for all), irrespective of sex. Men with altered sleep quality had higher HbA1c and prevalence of autoimmune diseases. Women showed greater prevalence of psychiatric disorders. Average HbA1c of the previous 36 months, autoimmune or psychiatric disorders were independent predictive factors for altered sleep quality.ConclusionOne-third of the patients with autoimmune diabetes showed altered sleep quality, which associates with worse glycemic control, and autoimmune and mental disorders, with sex-specific differences