Use of insulin degludec in pregnancy: two case reports and a literature review

Abstract As of now, insulin Degludec has no indication for use in pregnancy, because of the lack of studies that prove its safety for foetus. However it isn't infrequent that some women conceive while treating with insulin Degludec. So, before deciding to change the type of insulin therapy during pregnancy, an evaluation of the risk associated to a possible temporary worsening of glycaemic control, due to that insulin replacement, is needed. Referring to case series reported in the scientific literature could provide a support when a clinical decision need to be taken. We report two cases of women affected by type 1 diabetes who had unplanned pregnancies during treatment with insulin Degludec. In order to avoid the risk of a possible worsening of glycaemic control due to insulin switch, we decided to continue the treatment with Degludec during their pregnancies, after obtaining the patients' written informed consent. Daily insulin requirement gradually increased for both women pregnancy progressed, and glycated haemoglobin (HbA1c) values improved from the first observation to delivery: 55 mmol/mol (7.2%) at 9 weeks to 47 mmol/mol (6.5%) at 36 weeks, in Patient 1 (P1); 44 mmol/mol (6.2%) at 8 weeks to 33 mmol/mol (5.2%) at 36 weeks, in Patient 2 (P2). P1 delivered at week 37 with a caesarean section due to failed induction. The newborn, a girl of 3398 g at birth, developed neonatal hypoglycaemia and respiratory distress (Apgar 6-6). Six days after birth she underwent colectomy because of necrotizing enterocolitis and was finally diagnosed with atypical cystic fibrosis. P2 gave birth to a healthy girl (weight 2745g at birth, Apgar 7-9) at 37 weeks, undergoing a caesarean section for maternal cervical dystocia, without neonatal complications. Our experience provides additional evidence on the safety of insulin Degludec in pregnancy without any maternal or neonatal outcome suggesting its toxicity

ACTH-dependent Cushing's Syndrome: Diagnostic Pitfalls in Concomitant Non-secreting Pituitary Adenomas

Objectives: To describe the possible pitfalls in correctly interpreting clinical, radiological and biochemical findings in ACTH-dependent Cushing's syndrome. Methods: We describe a case of a pituitary adenoma visualized at MRI not correlated with an ACTH-dependent Cushing’s syndrome. Results: Radiological imaging and hormonal testing can be misleading in suspected pituitary ACTH-related Cushing’s syndrome. Conclusion: Correct interpretation of the initial clinical presentation can help in the proper diagnosis and treatment of ACTH-dependent Cushing’s syndrome

MICROWAVE-ASSISTED BRUCITE AND TALC REACTIONS WITH CO2 AS A PROXY FOR CARBON CAPTURE AND STORAGE BY SERPENTINE

In the last decades many studies have been focusing on Carbon Capture and Storage (CCS) to find a possible remedy to reduce the large increase of anthropogenic carbon dioxide (CO ). Mineral Carbonation (MC) is a potential solution for almost irreversible chemical long-term CCS. It concerns the combination of CaO and MgO with CO forming spontaneously and exothermically dolomite and magnesite. However, kinetic barriers pose sever limitations for the practical exploitation of this reaction. High fractions of MgO are available in silicates such as olivine, orthopyroxene, clinopyroxene and serpentine. To date, data reported that serpentine polymorphs, above all antigorite, is an excellent candidate for fixing the CO as the reaction efficiency is approximately 92% compared to lizardite (40%) and olivine (66%). This is due to the surface reactivity of approximately 18.7 m /g for the dehydrated antigorite compared to10.8 m /g for dehydrated lizardite and 4.6 m /g for olivine. The microwave assisted process for CCS is an innovative technology that can be employed to catalyze the reaction through thermal and non-thermal mechanisms. Some pioneering tests of direct carbonation by microwave hydrothermal equipment have been performed on olivine, lizardite and chrysotile powders [1] but not on antigorite. The structure of serpentine is characterized by corrugated stacked layers of silica and brucite. For this reason, MC involves dissolution of SiO layers, dissolution/dehydration of Mg(OH) layers, and precipitation of magnesium carbonate. To address the chemical response of the single phases, experiments have been performed by both a local microwave-source acting locally on a specific crystal surface and a volume source interacting with an ensemble of grains on synthetic powders and single crystals of pure brucite and talc. In a second step, treatments have been extended to chrysotile, lizardite and antigorite. A characterization of the mechanism and kinetics were performed by scanning probe microscopy on the surface of single crystals phases, supported by Raman spectroscopy and by Scanning and Transmission Electron Microscopy study performed on micro- and nano-sized grains. [1] White, et al. Reaction mechanisms of magnesium silicates with carbon dioxide in microwave fields. Final Report to the U.S. Department ofEnergy, National Energy Technology Laboratory (2004

Vibrational and nonlinear optical properties of amine-capped push-pull polyynes by infrared and Raman spectroscopy

The vibrational properties of a series of push-pull polyynes have been studied by infrared and Raman spectroscopy. The simultaneous activation of a strong infrared and Raman mode, i.e. the collective vibration of CC bonds of the sp carbon chain, highlights the effectiveness of a polyyne bridge in promoting charge transfer between the electron donor (D) and acceptor (A) ends, thus suggesting that ad-hoc functionalized polyynes are worth being explored as building blocks of organic materials with attractive first-order optical nonlinearity. The optical, electronic, and vibrational properties of these molecules have been investigated with the support of density functional theory calculations, as well as the electronic and vibrational first hyperpolarizabilities ($eta$). The mid-low region of the IR spectra (800-1600 cm$^{-1}$) has been analyzed in detail, searching for marker bands of the specific terminations of the different sp carbon chains thus achieving a complete vibrational characterization of sp hybridized push-pull systems

Haemorrhagic presentation of a craniopharyngioma in a pregnant woman

Objective. Craniopharyngioma is a rare tumour, and, consequently, acute clinical presentation and diagnosis, during pregnancy, of this pathology are quite difficult to find. Only few cases are reported in the literature, and no one describes these two conditions in association. Methods. We report a particular case of craniopharyngioma presenting both of the above conditions. Results. The patient was successfully operated with endoscopic technique. Conclusions. Rare and difficult cases, created by the superposition of different clinical conditions, need multidisciplinary management, with collaboration, integration, and cooperation between different medical specialists

Endothelial nitric oxide synthase polymorphisms are associated with type 2 diabetes and the insulin resistance syndrome

Endothelial nitric oxide synthase (eNOS) variants were previously demonstrated in cardiovascular disease. To evaluate whether eNOS gene variants are associated with insulin resistance and type 2 diabetes, we evaluated polymorphisms in Exon7 (E298D), intron 18 (IVS18 + 27A-->C), and intron 23 (IVS23 + 10G-->T) in 159 type 2 diabetic patients without macrovascular complications and in 207 healthy control subjects. Samples for all hormonal and metabolic variables were obtained after an overnight fast. The D298 and IVS18 + 27C alleles, but not the IVS23 + 10G-->T variant, were significantly more frequent in type 2 diabetic patients than in control subjects. The two- and three-loci haplotype analysis showed that there is a statistically significant association between the eNOS variants and type 2 diabetes. No significant differences were observed in the clinical characteristics of type 2 diabetic patients according to genotypes (except for visceral obesity [waist-to-hip ratio], which was significantly more present in D298 homozygotes). Healthy control subjects homozygous for both D298 and IVS18 + 27C presented higher insulin, C-peptide, and nitric oxide levels, as well as higher HOMA (homeostasis model assessment) values than the double wild-type homozygotes, with values superimposable on those found in type 2 diabetic patients. In conclusion, we described a significant association between eNOS gene polymorphisms and type 2 diabetes, suggesting a new genetic susceptibility factor for hyperinsulinemia, insulin resistance, and type 2 diabetes

Effect of normalization of fasting glucose by intensified insulin therapy and influence of eNOS polymorphisms on the incidence of restenosis after peripheral angioplasty in patients with type 2 diabetes: A randomized, open-label clinical trial

Primary objective was to evaluate whether an intensified insulin therapy (IIT) incorporating the target of normal fasting glucose and HbA1c levels could halve the incidence of restenosis/amputation/SCA/death at 6 months after peripheral angioplasty compared with standard care (SC) in patients with type 2 diabetes (DMT2) affected by critical limb ischemia (CLI). Forty-six consecutive patients with DMT2 and CLI were randomly assigned to a parallel, open-label study with IIT (basal-bolus glulisine + glargine administrations) or SC (glargine administration + oral antidiabetic drugs). A SNP of eNOS (rs753482-A>C) and circulating CD34+ and CD34+KDR + progenitor cells were determined. At the end of the study, although HbA1c levels were lower in IIT than in SC (6.9 ± 1.3 % vs. 7.6 ± 1.2 %, p C SNP) and circulating endothelial progenitor cells. © 2012 Springer-Verlag