Increased Urinary Albumin Excretion, Insulin Resistance, and Related Cardiovascular Risk Factors in Patients With Type 2 Diabetes

OBJECTIVE—While the relevant role of insulin resistance in the pathogenesis of increased urinary albumin excretion (UAE) is well established in type 1 diabetes, its contribution in type 2 diabetes is controversial. Our aim was to investigate whether insulin resistance was associated with increased UAE in a large cohort of patients with type 2 diabetes. RESEARCH DESIGN AND METHODS— A total of 363 men and 349 women, aged 61 ± 9 years, with a disease duration of 11 ± 9 years and HbA1c levels of 8.6 ± 2.0% were included. Insulin resistance was derived from the homeostasis model assessment of insulin resistance (HOMAIR), and UAE was derived from the albumin-to-creatinine ratio (ACR) defined as increased if the value was ≥2.5 mg/mmol in men and ≥3.5 mg/mmol in women. ACR was correlated with HOMAIR (r = 0.15, P = 0.0001), independently of age, disease duration, blood pressure, HbA1c, triglycerides, waist circumference, and smoking. RESULTS—When the two sexes were investigated separately, a significant correlation between ACR and HOMAIR was reached in men (n = 363; r = 0.21, P = 0.0001) but not women (n = 349; r = 0.08, P = 0.14), suggesting that insulin resistance and sex may interact (P for interaction = 0.04) in determining UAE. When men were subgrouped into quartiles of HOMAIR, those of the third and fourth quartile (i.e., the most insulin resistant) were at higher risk to have increased ACR than patients of the first quartile (third quartile: odds ratio 2.2 [95% CI 1.2–4.2], P = 0.01) (fourth quartile: 4.1 [2.2–7.9], P = 0.00002). Finally, ACR was significantly higher in men with two or more insulin resistance–related cardiovascular risk factors (i.e., abdominal obesity, dyslipidemia, and arterial hypertension) than in men with fewer than two insulin resistance–related cardiovascular risk factors (0.90 [0.2–115.1] vs. 1.56 [0.1–1367.6], respectively, P = 0.005). CONCLUSIONS—In type 2 diabetic patients, increased UAE is strongly associated with insulin resistance and related cardiovascular risk factors. This association seems to be stronger in men than in women

Orbital and Periorbital Emphysema Following Maxillary Sinus Floor Elevation: A Case Report and Literature Review

During the past 150 years, subcutaneous emphysema has been described as a rare complication in dentistry, the etiology of which might be maneuvers performed by the patient (eg, sneezing while the mouth is closed, blowing the nose) or the dental professional through the use of specific dental instruments (eg, dental drill, air syringe, etc). Irrespective of etiology, air is forced through the soft tissues, thus producing rapid swelling of the area. According to the most recent literature reviews, the iatrogenic etiology is the most frequent. This report describes the first case of emphysema related to the orbital and periorbital region after a maxillary sinus floor elevation procedure

Significance of a simplified method for periodontal risk assessment in predicting periodontitis recurrence during supportive periodontal therapy: a retrospective cohort study

Aim: To evaluate whether patient-related risk scores generated with a simplified method for periodontal risk assessment (UniFe; Trombelli et al. 2009) may predict periodontitis recurrence during supportive periodontal therapy (SPT). Material and Methods: At 2 clinical centers, data were retrospectively obtained from the record charts of 109 patients (age range: 22\u201362 years). According to the individual treatment plan, patients had undergone active periodontal therapy (APT) and had been enrolled in a SPT program for a mean of 5.6 2.2 years. Patient-related risk scores referred to the first visit following APT were calculated on a scale from 1 (low risk) to 5 (high risk) according to UniFe. Patients were grouped according to risk scores and compared for tooth loss as well as changes in radiographic bone levels and pocket probing depth (PPD) occurred during SPT. Results: After APT, 5, 6, 20, 65, and 13 patients showed a risk score of 1, 2, 3, 4 and 5, respectively. The mean number of teeth lost during SPT ranged from 0 to 1.8 2.5 teeth in patients with a risk score of 1 and 5, respectively (p = 0.041), with a mean yearly rate between 0 (risk score 1) and 0.32 0.51 teeth/year (risk score 5) (p = 0.053). Mean bone loss and PPD increase during SPT were both 640.50 mm in all risk groups, without inter-group differences. Conclusion: Within its limits, the present study indicate that risk assessment according to the UniFe method may help to identify patients at risk for tooth loss during SPT

Protocollo di assessment delle dimensioni autistica e psicotica per i Centri di Salute Mentale che si interfacciano con la Neuropsichiatria Infantile

Questo articolo nasce dall'esperienza di un gruppo di lavoro costituito da neuropsichiatri infantili e psichiatri esperti di autismo, che ha messo a punto un protocollo multi-stadio per approfondire, da un lato la dimensione psicotica in pazienti appartenenti allo spettro autistico, dall'altro la dimensione autistica in pazienti appartenenti allo spettro schizofrenic

Coeliac Disease in the Elderly. A multicentre Italian study

In the last few decades, we have observed either an increased incidence of coeliac disease (CD) or an increased frequency of its diagnosis. However, only scant information is available about the prevalence and clinical features of CD in the elderly.To determine the proportion of elderly patients (age > or =65 years) in a large group of consecutive newly-diagnosed cases of adult CD and to analyze the clinical pattern and causes of death.1,353 adult patients with active CD were diagnosed by 10 Italian Gastroenterology Units over a period of 10 years. For each patient, a questionnaire comprising demographic data, signs and symptoms with their duration at the moment of the diagnosis, and associated diseases or complications and the causes of death, was drawn up.A total of 60 patients (4.4\%) were over 65 years at diagnosis with a M/F ratio of 1/2.75 which was similar to 1/2.42 in the under-65-year age group. The mean time of delayed diagnosis was 17 +/- 19 years in the elderly and 14 +/- 13.8 years in the adults. Classical features of malabsorption were the main presenting symptoms and gastrointestinal disorders were very often also present in the geriatric patients. Twelve aged subjects (20\%) died during the follow-up period (mean 4.6 years) often due to cachexia (5\%) and heart failure (5\%), even though complications such as intestinal lymphoma were present in 8.3\% of cases and caused death in 3.3\% of the elderly.In spite of classical manifestations of CD in the elderly, the diagnosis was made in only 4.4\% of subjects aged over 65 years and the delay was 17 years. These observations, together with the shortening of life expectancy of elderly CD patients, emphasize the importance for clinicians to consider CD as a possible diagnosis and the need for further investigations to be carried out in the elderly general population

A multistep approach for the stratification of the risk of severe hypoglycemia in patients with type 2 diabetes

INTRODUCTION: Hypoglycemia is the major limiting factor in the glycemic management of diabetes. Aim of this study was to produce a risk stratification tool to support the medical decision making, by facilitating the identification of patients at higher risk of hypoglycemia. EVIDENCE ACQUISITION: A multistep approach was adopted, including a systematic review of observational studies investigating risk factors for severe hypoglycemia in type 2 diabetes (T2DM), followed by an expert input forum to identify factors perceived as relevant and at the same time reliably detectable, to be used for the development of a risk score. EVIDENCE SYNTHESIS: The systematic review led to the identification of 41 studies. Many factors have been seldom investigated, and their association with the risk of hypoglycemia is still unclear. Factors more frequently associated with a high risk of hypoglycemia were: low level of education, ethnicity, irregular meals/malnutrition, insulin and sulfonylurea therapy, polypharmacy, previous hypoglycemia, impaired renal function, cognitive impairment, depression and frailty. The expert input forum involved 35 diabetologists. Following the ranking of the relevance of the factors identified, a parsimonious yet comprehensive set of risk factors was identified. CONCLUSIONS: The process led to the identification of relevant factors, to be used for the development of a hypoglycemia risk score. An ad-hoc study will be performed to assess the contribution of these risk factors and their relative weight. If the risk score will confirm its ability to correctly stratify patients according to their risk of hypoglycemia, it will represent a useful support to optimize the care of people with T2DM