Metformin and Covid-19: a systematic review of systematic reviews with meta-analysis

: the COVID-19 infection, caused by severe Coronavirus 2 syndrome (Sars-Cov-2), immediately appeared to be the most tragic global pandemic event of the twentieth century. Right from the start of the pandemic, diabetic patients treated with metformin experienced a reduction in mortality and complications from COVID-19 compared to those with different treatments or no treatment. Objective The main objective of the study was to observe the effects of metformin in hospitalized subjects infected with COVID-19. Specifically, the outcomes of hospitalization in Intensive Care Units or death were examined. Materials and Methods A specific research PICOS was developed and the Pubmed, Embase and Scopus databases were consulted down to April 30, 2022. To estimate the extent of the metformin effect and risk of severity in SARS-CoV-2 infection, the Odd Ratio (OR) with 95% Confidence Interval (CI) published by the authors of the selected systematic reviews was used. Results from five systematic reviews 36 studies were selected. The final meta-analysis showed that thanks to treatment with metformin, DM2 patients affected by COVID-19 had protection against risk of disease severity, complications (ES 0.80; 95% CI) and mortality (ES 0.69; 95% CI). Conclusions More in-depth studies on the use of metformin, compared to other molecules, may be required to understand the real protective potential of the drug against negative outcomes caused by COVID-19 infection in DM2 patients

To verify four 5-year-old mathematical models to predict the outcome of ICU patients

The aim of this study is to verify calibration and discrimination after 5 years in the case mix of patients admitted to the Intensive Care Unit (ICU) during the year 2000. In this way we want to perform a quality control of our ICU in order to justify the increased amount of money spent for intensive care.A prospective study has been made on the 357 patients admitted to the ICU during the year 2000. The Apache II score was calculated within the first 24 hours and, depending on the length of stay in the ICU, on the 5(th), 10(th) and 15(th) day after ICU admission. On the basis of the 4 mathematical models death risk has been calculated for each of the 4 times. The Hosmer-Lemeshow test was performed for calibration and ROC curves for discrimination, always for each of the 4 mathematical models.The 1(st) model, at 24 hours from ICU admission, showed a bad calibration (p=0.000088), while the ROC curve was 0.744+/-0.32. Also the 2(nd) model, at the 5(th) day from admission, showed a bad calibration (p=0.000588), with ROC curve of 0.827+/-0.04. The 3(rd) model (10(th) day), was well calibrated (p=0.112247) and discriminating (ROC=0.888 +/-0.04). Finally the models at 15 days showed again a bad calibration (p=0.001422) but a very good discrimination (area=0.906+/-0.06).Developing mathematical models to predict mortality within ICUs can be useful to assess quality of care, even if these models should not be the only ICU quality controls, but must be accompanied by other indicators, looking at quality of life of the patients after ICU discharge

Association of kidney disease measures with risk of renal function worsening in patients with type 1 diabetes

Background: Albuminuria has been classically considered a marker of kidney damage progression in diabetic patients and it is routinely assessed to monitor kidney function. However, the role of a mild GFR reduction on the development of stage 653 CKD has been less explored in type 1 diabetes mellitus (T1DM) patients. Aim of the present study was to evaluate the prognostic role of kidney disease measures, namely albuminuria and reduced GFR, on the development of stage 653 CKD in a large cohort of patients affected by T1DM. Methods: A total of 4284 patients affected by T1DM followed-up at 76 diabetes centers participating to the Italian Association of Clinical Diabetologists (Associazione Medici Diabetologi, AMD) initiative constitutes the study population. Urinary albumin excretion (ACR) and estimated GFR (eGFR) were retrieved and analyzed. The incidence of stage 653 CKD (eGFR < 60 mL/min/1.73 m2) or eGFR reduction > 30% from baseline was evaluated. Results: The mean estimated GFR was 98 \ub1 17 mL/min/1.73m2 and the proportion of patients with albuminuria was 15.3% (n = 654) at baseline. About 8% (n = 337) of patients developed one of the two renal endpoints during the 4-year follow-up period. Age, albuminuria (micro or macro) and baseline eGFR < 90 ml/min/m2 were independent risk factors for stage 653 CKD and renal function worsening. When compared to patients with eGFR > 90 ml/min/1.73m2 and normoalbuminuria, those with albuminuria at baseline had a 1.69 greater risk of reaching stage 3 CKD, while patients with mild eGFR reduction (i.e. eGFR between 90 and 60 mL/min/1.73 m2) show a 3.81 greater risk that rose to 8.24 for those patients with albuminuria and mild eGFR reduction at baseline. Conclusions: Albuminuria and eGFR reduction represent independent risk factors for incident stage 653 CKD in T1DM patients. The simultaneous occurrence of reduced eGFR and albuminuria have a synergistic effect on renal function worsening

THE USE OF ICT FOR SOCIAL INCLUSION AND PARTECIPATIVE PLANNING. A CASE STUDY OF “SOUTH-NORTH” TECHNOLOGY TRANSFER

The proposed paper aims to address the use of ICT for social inclusion. In peculiar this research study and experimentation examine both the application of participative methods and techniques, which support the community to identify problems and resources, and the possibility to integrate data and tools with the ones used by public stakeholders, as a starting point for future interventions. Participative planning is then intended as a way to think over the public action, either in the relationship with citizens or in the public space management. The proposed subject takes cue from the “Crowdmapping Mirafiori Sud” project outcomes. The project has been granted with 5x1000 funds from Politecnico di Torino for student projects and is now in the final phase. The aim of the project is to conduct a pilot experience in a participative and inclusive way in order to identify and categorize – returning information on a geographic map – the nature, the location and consistency of the obstacles/barriers which prevent vulnerable categories to access and use the public spaces of their neighbourhood

"NURSE CASE MANAGER LIFESTYLE MEDICINE IN TYPE TWO DIABETES PATIENT CONCERNING COVID-19 PANDEMIC: INTEGRATED REVIEW"

Background American Case Manager Association defines Case Management (CM) as a collaborative practice between all the actors involved in the care process. The main goal of the review was evaluation of the Nurse Case Manager (NCM) in Type 2 Diabetes (T2D) in LM perspective, analyzing the qualitative/quantitative data related to NCM. Methods The review was conducted by three independent operators in two distinct phases. The Prisma method was perfor- med for both parts of study. Specifics PICOS and research strategies from PubMed and Cinhal were developed. The first part of the review integrated a Cochrane systematic review on the Specialist Nurses in Diabetes Mellitus while the second part to evaluated the NCM interventions in LM perspective. Results In the first part of the review 13 studies were included while in the second 6. From the data collected, emerged that the glycemic control improved in most revised studies in the NCM groups or Nurse Case Manager Lifestyle Medicine (NCMLM) perspective. Good results were appreciated with respect to secondary outcomes such as lipid profile, Body Mass Index, quality of life and stress management. The results for the management of self-care and adherence to LM programs are encouraging. Conclusions After Covid-19 Pandemic, diabetic population, will necessarily have to be assisted by management and organi- zational tools that can still maintain high levels of general quality of life. The managers of health services could consider NCMLM for the improvement of care in T2D patients. Specific studies could assess potential of NCMLM

Correlation between hyperglycemia and mortality in a medical and surgical intensive care unit

Abstract AIM: The aim of this study was to assess the correlation between hyperglycemia and mortality in a group of patients admitted to a medical and surgical ICU and to evaluate if the association between hyperglycemia and reason of ICU admission significantly worsens patients' outcomes. METHODS: A retrospective clinical study was conducted in the ICU of a University Hospital. Four-hundred and twelve adult patients admitted to our ICU were enrolled. The blood glucose level was measured at the time of admission and daily at 2-4 h intervals. When the glucose level exceeded 180 mg/dL, an insulin bolus or a continuous infusion were performed to maintain the glucose level at or below 180-200 mg/dL. RESULTS: Analysing the mean blood glucose levels of patients with the receiver operating characteristic (ROC) curve, it resulted that the blood glucose level of 141.7 mg/dL had higher sensitivity (76%) and specificity (56.5%) to discriminate the probability of death. In other words, in pati..

Tur(i)ntogreen. A competition for agro-urban visions for a renewable future

The paper aims to present the results of the tur(i)ntogreen initiative - organized by the CRD-PVS (Politecnico di Torino - IT) and backed by UN-HABITAT - on low-carbon visions for urban neighbourhood. The boundaries of the contemporary cities are transforming together with the changing in the citizens’ life perspective. The fragile and lost balance between ‘rural’ and ‘urban’ is quickly evolving. Younger generations from the rural areas in the world keep moving toward cities, claiming the right to share the benefits supplied by services, wealth and employment. Turin - the Italian motown – has been traditionally the home for people coming from other sides of the Country and now of the World. South Mirafiori neighbourhood represents the heritage of what the idea of an endless urban development and growth left in our cities. Not flexible and energy wasting buildings, hard to be adjusted to the new model of families and their needs, these areas are one of the contemporary urban challenges. Nevertheless, being often located in the urban outskirts make them privileged points to reflect on the urban de-growth. The paper outlines the competition brief, defined by crossing topics such as urban agriculture, energy neighbourhood, low carbon design, shared spaces for seasonal workers and community engagement