Chronic obstructive pulmonary disease and diabetes

Diabetes occurs more often in individuals with COPD than in the general population, however there are still many issues that need to be clarified about this association. The exact prevalence of the association between diabetes and COPD varies between studies reported, however it is known that diabetes affects 2–37 % of patients with COPD, underlining the need to better understand the link between these two conditions. In this review, we evaluated the epidemiological aspects of the association between diabetes and COPD analyzing potential common issues in the pathological mechanisms underlying the single disease. The close association suggests the occurrence of similar pathophysiological process that leads to the development of overt disease in the presence of conditions such as systemic inflammation, oxidative stress, hypoxemia or hyperglycemia. Another, but not less important, aspect to consider is that related to the influence of the pharmacological treatment used both for the patient affected by COPD and from that affected by diabetes. It is necessary to understand whether the treatment of COPD affect the clinical course of diabetes, it is also essential to learn whether treatment for diabetes can alter the natural history of COPD

LIFE-THREATENING HYPOCALCEMIA IN A PATIENT WITH HIGHLY SUSPECTED OSTEOMALACIA: A CASE REPORT

ABSTRACT: Objective: Osteomalacia is a metabolic bone disease characterized by impaired mineralization with increased non-mineralized osteoid tissue, increased frailty, and reduced bone mineral density. A common cause of osteomalacia in adults and the elderly is severe deficiency of vitamin D, which leads to chronic hypocalcemia, hypophosphatemia, and secondary hyperparathyroidism. The objective of this case report is to describe an unusual clinical presentation of osteomalacia, consisting of life-threatening acute hypocalcemia.Methods: Clinical, laboratory, and imaging data are presented.Results: We report the case of a 65-year-old man that showed symptoms and signs of severe and prolonged hypocalcemia due to unrecognized vitamin D deficiency. He presented at the emergency room reporting abdominal pain and vomiting since the evening before. Blood tests showed increased levels of rhabdomyolysis markers, severe hypocalcemia, hypophosphatemia, hypomagnesemia, normal renal function, elevated levels of alkaline phosphatase, extremely high levels of parathyroid hormone, and hypovitaminosis D. Radiological skeletal features of bone demineralization and bone abnormalities suggestive of osteomalacia were additionally detected. Other secondary causes of hypocalcemia were excluded. Clinical and biochemical resolution were progressively obtained only after an intramuscular loading dose of cholecalciferol was added to the standard calcium intravenous replacement therapy.Conclusion: This case report shows that osteomalacia consequent to a severe vitamin D deficiency can present with acute symptoms and signs of severe hypocalcemia requiring hospital admission. In such cases, vitamin D administration, and not intensive calcium supplementation alone, is essential to achieve clinical resolution of symptoms and normalization of mineral metabolism parameters.Abbreviations: 25-OH-D 25-hydroxyvitamin D CT computed tomography IV intravenous PTH parathyroid hormon

Drug interactions of direct oral anticoagulants in elderly patients with cardiometabolic diseases

In the present review we summarized current knowledge about significant interactions (DIs) of direct oral anticoagulants (DOACs) with other medications frequently prescribed to elderly patients with cardiometabolic diseases. Literature search was performed using PubMed from 1990 to October 2020. Randomized clinical trials (RCTs), subgroup analyses from RCTs, longitudinal studies, case series and case reports were included. Only studies in humans were considered. Elderly was defined as ≥75 years. Assessment of DIs with DOACs is often tricky because of the lack of validated tools to routinely assess magnitude of their anti-coagulation effect. Most of reports in the cardiometabolic area regarded the classes of anti-antiarrhythmic, lipid-lowering and platelet-inhibitors drugs, namely drugs that are widely used to reduce cardiovascular risk in patients with common metabolic diseases. Reports about elderly are limited in general, and it is not known whether certain types of DIs occur more frequently in elderly subjects. DIs were more frequently reported in association with dabigatran, which however has been available for a longer period of time compared with other DOACs. In most cases, no complete information about dosages of medications was available. DIs of DOACs leading to adverse events (both ischemic and bleeding ones) were generally facilitated by older age, polymedication and impaired renal function. Further studies should be carried out to properly investigate DIs of DOACs with cardiometabolic drugs in elderly patients, with particular focus on differences between DOACs and the influence of different dosages

Glucose variability: a new risk factor for cardiovascular disease

Aims and data synthesis: glucose variability (GV) is increasingly considered an additional index of glycemic control. Growing evidence indicates that GV is associated with diabetic vascular complications, thus being a relevant point to address in diabetes management. GV can be measured using various parameters, but to date, a gold standard has not been identified. This underscores the need for further studies in this field also to identify the optimal treatment. Conclusions: We reviewed the definition of GV, the pathogenetic mechanisms of atherosclerosis, and its relationship with diabetic complications

Hyperglycaemia and Chronic Obstructive Pulmonary Disease

: Chronic obstructive pulmonary disease (COPD) may coexist with type 2 diabetes mellitus (T2DM). Patients with COPD have an increased risk of developing T2DM compared with a control but, on the other side, hyperglycaemia and DM have been associated with reduced predicted levels of lung function. The mechanistic relationships between these two diseases are complicated, multifaceted, and little understood, yet they can impact treatment strategy. The potential risks and benefits for patients with T2DM treated with pulmonary drugs and the potential pulmonary risks and benefits for patients with COPD when taking antidiabetic drugs should always be considered. The interaction between the presence and/or treatment of COPD, risk of infection, presence and/or treatment of T2DM and risk of acute exacerbations of COPD (AECOPDs) can be represented as a vicious circle; however, several strategies may help to break this circle. The most effective approach to simultaneously treating T2DM and COPD is to interfere with the shared inflammatory substrate, thus targeting both lung inflammation (COPD) and vascular inflammation (DM). In any case, it is always crucial to establish glycaemic management since the reduction in lung function found in people with diabetes might decrease the threshold for clinical manifestations of COPD. In this article, we examine possible connections between COPD and T2DM as well as pharmacological strategies that could focus on these connections

The complex architecture of the 2009 MW 6.1 L’Aquila normal fault system (Central Italy) as imaged by 64,000 high-resolution aftershock locations.

On April 6th 2009, a MW 6.1 normal faulting earthquake struck the axial area of the Abruzzo region in Central Italy. We present high-precision hypocenter locations of an extraordinary dataset composed by 64,000 earthquakes recorded at a very dense seismic network of 60 stations operating for 9 months after the main event. Events span in magnitude (ML) between -0.9 to 5.9, reaching a completeness magnitude of 0.7. The dataset has been processed by integrating an accurate automatic picking procedure together with cross-correlation and double-difference relative location methods. The combined use of these procedures results in earthquake relative location uncertainties in the range of a few meters to tens of meters, comparable/lower than the spatial dimension of the earthquakes themselves). This data set allows us to image the complex inner geometry of individual faults from the kilometre to meter scale. The aftershock distribution illuminates the anatomy of the en-echelon fault system composed of two major faults. The mainshock breaks the entire upper crust from 10 km depth to the surface along a 14-km long normal fault. A second segment, located north of the normal fault and activated by two Mw>5 events, shows a striking listric geometry completely blind. We focus on the analysis of about 300 clusters of co-located events to characterize the mechanical behavior of the different portions of the fault system. The number of events in each cluster ranges from 4 to 24 events and they exhibit strongly correlated seismograms at common stations. They mostly occur where secondary structures join the main fault planes and along unfavorably oriented segments. Moreover, larger clusters nucleate on secondary faults located in the overlapping area between the two main segments, where the rate of earthquake production is very high with a long-lasting seismic decay

Exploring the cosmological synergy between galaxy cluster and cosmic void number counts

Galaxy clusters and cosmic voids are the most extreme objects of our Universe in terms of mass and size, tracing two opposite sides of the large-scale matter density field. By studying their abundance as a function of their mass and radius, respectively, i.e. the halo mass function (HMF) and void size function (VSF), it is possible to achieve fundamental constraints on the cosmological model. While the HMF has already been extensively exploited providing robust constraints on the main cosmological model parameters (e.g. $\Omega_{\rm m}$, $\sigma_8$ and $S_8$), the VSF is still emerging as a viable and effective cosmological probe. Given the expected complementarity of these statistics, in this work we aim at estimating the costraining power deriving from their combination. To achieve this goal, we exploit realistic mock samples of galaxy clusters and voids extracted from state-of-the-art large hydrodynamical simulations, in the redshift range $0.2 \leq z \leq 1$. We perform an accurate calibration of the free parameters of the HMF and VSF models, needed to take into account the differences between the types of mass tracers used in this work and those considered in previous literature analyses. Then, we obtain constraints on $\Omega_{\rm m}$ and $\sigma_8$ by performing a Bayesian Markov Chain Monte Carlo analysis. We find that cluster and void counts represent powerful independent and complementary probes to test the cosmological framework. In particular, we found that the constraining power of the HMF on $\Omega_{\rm m}$ and $\sigma_8$ improves drastically with the VSF contribution, increasing the $S_8$ constraint precision by a factor of about $60\%$.Comment: 12 pages, 7 figures, submitted to MNRA

Metabolic Syndrome, Chronic Kidney, and Cardiovascular Diseases: Role of Adipokines

Obesity is a chronic disease, whose incidence is alarmingly growing. It is associated with metabolic abnormalities and cardiovascular complications. These complications are clustered in the metabolic syndrome (MetS) leading to high cardiovascular morbidity and mortality. Obesity predisposes to diabetic nephropathy, hypertensive nephrosclerosis, and focal and segmental glomerular sclerosis and represents an independent risk factor for the development and progression of chronic kidney disease (CKD). Albuminuria is a major risk factor for cardiovascular diseases (CVDs). Microalbuminuria has been described as early manifestation of MetS-associated kidney damage and diabetic nephropathy. Obesity and MetS affect renal physiology and metabolism through mechanisms which include altered levels of adipokines such as leptin and adiponectin, oxidative stress, and inflammation. Secretory products of adipose tissue also deeply and negatively influence endothelial function. A better understanding of these interactions will help in designing more effective treatments aimed to protect both renal and cardiovascular systems

SEISMIC ANISOTROPY AND ITS RELATION WITH FAULTS AND STRESS FIELD IN THEVAL D'AGRI (SOUTHERN ITALY).

Shear-wave splitting is measured at 17 seismic stations deployed in the Val DAgri by INGV, which recorded local back-ground seismicity from May 2005 to June 2006 . The splitting results suggest the presence of an anisotropic upper crust (max hypocentral depth 15.5 km). The dominant fast polarisation direction strikes NW-SE parallel to the Apennines orogen and is approximately parallel to the maximum horizontal stress in the region and also parallel to the strike of the main normal faults in the Val DAgri. The size of the delay times, average is 0.1 second suggests 4.5% shear-wave velocity anisotropy. At stations located at the North West portion of the deployment average delay times are larger on the order of 0.2s. These parameters agree with an interpretation of seismic anisotropy in terms of the Extensive-Dilatancy Anisotropy model which considers the rock volume to be pervaded by fluid-saturated microcracks aligned by the active stress field. We cannot completely rule out the contribution of aligned macroscopic fractures as the cause of the shear wave anisotropy even if the parallel shear-wave polarisations we found are diagnostic of transverse isotropy with a horizontal axis of symmetry. This symmetry is commonly explained by parallel stress-aligned microcracks