Levofloxacin-induced life-threatening hypoglycemia in a type 2 diabetic patient with ST-segment elevation myocardial infarction and community-acquired pneumonia

Levofloxacin is a broad-spectrum, third-generation fluoroquinolone antibiotic used in the treatment of respiratory and urinary tract infections. Although it is usually well-tolerated, it may cause life-threatening adverse effects, including severe hypoglycemia. We present a case of levofloxacin-induced life-threatening hypoglycemia in a 87-year-old type 2 diabetic patient with ST-segment elevation myocardial infarction and community-acquired pneumonia. Hypoglycemia secondary to levofloxacin is a rare complication (< 0,1%), but can be more common among elderly patients, with type 2 diabetes (especially treated with hypoglycemic drugs) or renal dysfunction. Our patient was at high risk due to age, diabetes and chronic kidney disease (creatinine 149 μmol/L, estimated glomerular filtration rate 27 mL/min/1.73 m²). In the Naranjo probability scale, the patient scored 5 points, which indicates that hypoglycemia was a probable levofloxacin-related adverse effect. In conclusion, we suggest that levofloxacin should be used with greater caution, particularly in patients at increased risk of hypoglycemia

Rola krążącego receptora dla IL-33 (sST2) w monitorowaniu terapii niewydolności serca

Heart failure (HF) is currently one of the major health problems in Poland and in other European countries. Despite the progress that has been made in the treatment of HF, mortality and the incidence of re-hospitalization for HF are still very high. One of the reasons is the lack of proper heart failure treatment optimization.Among the currently studied new biomarkers of heart failure, one of the special interest is circulating receptor for IL-33 (sST2). It has been shown that IL-33 plays cardioprotective role. Its molecular mechanisms of action are based mainly on the activation of the transmembrane form of ST2 receptor (ST2L). Availability of IL-33 for ST2L is limited by binding to the soluble fraction of the ST2 (sST2) — called a „decoy receptor”.The presence of elevated levels of sST2 in the population of patients with heart failure is associated with more severe left ventricular remodeling, impaired diastolic function and right ventricle function. Patients with both HF and high and/or rising levels sST2 are at high risk of adverse cardiovascular events.The standard treatment for heart failure leads to reduction in sST2 concentration. Among the drugs used in the heart failure treatment, two with the largest impact on reducing concentration of sST2 are beta-blockers in high doses, and aldosterone.Niewydolność serca (HF) jest obecnie jednym z najważniejszych problemów zdrowotnych w Polsce i w innych krajach europejskich. Mimo postępu, jaki dokonał się w leczeniu HF, umieralność i częstość ponownych hospitalizacji z powodu HF wciąż są bardzo wysokie. Jedną z przyczyn takiego stanu rzeczy jest brak właściwej optymalizacji leczenia niewydolności serca.Wśród aktualnie badanych, nowych biomarkerów niewydolności serca szczególne zainteresowanie wzbudza krążący receptor dla IL-33 (sST2). Wykazano, że IL-33 ma działanie kardioprotekcyjne. Molekularne mechanizmy korzystnego działania IL-33 w układzie krążenia opierają się w głównej mierze na aktywacji przezbłonowej postaci receptora ST2 (ST2L). Dostępność IL-33 dla ST2L jest ograniczona przez wiązanie się jej z rozpuszczalną frakcją ST2 (sST2) — tak zwanym receptorem pułapką (decoy receptor). Podwyższone stężenia sST2 w populacji pacjentów z niewydolnością serca wiążą się z występowaniem bardziej nasilonego remodelingu lewej komory, upośledzeniem jej czynności rozkurczowej oraz gorszą funkcją prawej komory. Chorzy z HF i wysokimi i/lub narastającymi stężeniami sST2 stanowią grupę wysokiego ryzyka niekorzystnych zdarzeń sercowo-naczyniowych.Standardowe leczenie niewydolności serca prowadzi do zmniejszenia stężeń sST2. Wśród leków modyfikujących przebieg niewydolności serca największy wpływ na redukcję stężenia sST2 mają beta-adrenolityki w dużych dawkach oraz antagoniści aldosteronu

Relationship among the leptin-to-adiponectin ratio, systemic inflammation, and anisocytosis in well-controlled type 2 diabetic patients with atherosclerotic cardiovascular disease

Background: Previous studies have shown that red blood cell distribution width (RDW) is an independent predictor of poor prognosis in type 2 diabetes (T2D) and atherosclerotic cardiovascular disease (ASCVD). The mechanisms underlying increased anisocytosis in patients with T2D and confirmed ASCVD remain poorly understood. Aims: We sought to evaluate the relationship among the leptin-to-adiponectin ratio, systemic low -grade inflammation, and RDW in optimally treated patients with T2D and established ASCVD. Methods: A total of 68 patients, aged 47 to 85 years (mean [SD], 65.3 [6.8] years) and including 21 women (30.9%), were enrolled and grouped according to median RDW into those with RDW &lt; 13.5% (n = 33) and those with RDW ≥13.5% (n = 35). Results: Patients with RDW ≥13.5% had a significantly higher median (interquartile range [IQR]) serum leptin-to-adiponectin ratio (1.7 [0.49–2.3] ng/μg vs 0.66 [0.31–1.25] ng/μg; P = 0.04) and median (IQR) tumor necrosis factor α levels (1.58 [1.42–1.97] pg/ml vs 1.39 [1.18–1.57] pg/ml; P = 0.02). There were no significant differences in the concentrations of other inflammatory markers. The leptin-to-adiponectin ratio (r = 0.25; P = 0.04) and levels of tumor necrosis factor α (r = 0.32; P = 0.01) and soluble intercellular adhesion molecule 1 (r = 0.31; P = 0.01) were positively correlated with RDW, which was confirmed by univariate linear regression analysis. A multivariable regression model, which included demographic, clinical, and laboratory data, showed that white blood cell count (β = 0.25; 95% CI, 0.05–0.45; P = 0.01), soluble intercellular adhesion molecule 1 levels (β = 0.21; 95% CI, 0.02–0.41; P = 0.03), and mean corpuscular hemoglobin concentration (MCHC), (β = –0.48; 95% CI, 0.67 to –0.28; P &lt; 0.001) were independent predictors of RDW in our patients. Conclusions: In well-controlled patients with T2D and ASCVD, the RDW values are associated with leptin-to-adiponectin imbalance and selected inflammatory markers

Spontaneous recanalisation of the superficial femoral artery following angioplasty of the femoral artery in a patient with disseminated atherosclerosis : a case report

We present a case of a 51-year-old male with multivessel coronary artery disease and disseminated peripheral arterial disease (PAD) who underwent coronary angioplasty, followed by angioplasty with stent implantation of the left superficial iliac artery and right femoral artery. Thirty days later the patient was admitted for elective angioplasty of the previously closed superficial right femoral artery; however, angiography showed that the artery was patent with a residual stenosis which narrowed the vessel lumen by 10%. We believe that spontaneous recanalisation of this artery was caused by multiple factors, including cessation of smoking, physical training, pharmacological therapy and previous angioplasty of the right femoral arter

Myocardial dysfunction and chronic heart failure in patients with long-lasting type 1 diabetes : a 7-year prospective cohort study

The aim of the study is to evaluate the prevalence and incidence of myocardial dysfunction (MD) and heart failure (HF) in long-lasting (≥10 years) type 1 diabetes without cardiovascular disorders or with hypertension or coronary heart disease (CHD). The study included 1,685 patients with type 1 diabetes (mean baseline age, 51 years; diabetes duration, 36 years). In all patients, echocardiography was performed, NT-proBNP levels were measured, and clinical symptoms were evaluated. A 7-year follow-up was conducted to monitor systolic and diastolic manifestations of MD and HF. At the end of the follow-up period, the prevalence of HF in the entire group was 3.7 %, and the incidence was 0.02 % per year. The prevalence of MD was 14.5 % and the incidence –0.1 % per year. MD and HF were observed only in hypertensive or CHD patients. At baseline, subjects with diastolic HF constituted 85 % of the HF population and those with systolic HF the remaining 15 %. Baseline HF predictors included age, diabetes duration, HbA(1c) levels, CHD, systolic blood pressure >140 mmHg, and GFR <60 mL/min/1.73 m(2). In patients with type 1 diabetes, MD and HF occurred only when diabetes coexisted with cardiovascular disorders affecting myocardial function. The prevalence and incidence of HF in patients with hypertension and CHD were relatively low. While the cause of this observation remains uncertain, it could probably be explained, at least partially, by the cardioprotective effect of concomitant treatment