Insulin autoimmune syndrome in an Argentine woman taking α-lipoic acid: A case report and review of the literature.

Insulin autoimmune syndrome is an unusual cause of spontaneous hypoglycaemia in non-Asian populations. In the majority of cases, this syndrome appears a few weeks after the administration of drugs containing a sulfhydryl group. A strong association between this syndrome and HLA-DR4 has been shown. Only seven cases have been described in non-Asian patients. We report the first case of insulin autoimmune syndrome in an Argentine woman taking alfa-lipoic acid. She developed hypoglycaemic symptoms approximately 1 month after starting therapy. Blood sampling collected during an episode of symptomatic hypoglycaemia showed low blood glucose level (2.39 mmol/L), high level of serum insulin (1971.55 pmol/L), inappropriately high level of C-peptide (2.36 nmol/L) and high levels of insulin antibodies (274.78 IU/mL). HLA-DNA typing identified DRB1*04:03. Due to the widespread use of alfa-lipoic acid for its antioxidant properties, clinicians should be aware that it may trigger an autoimmune hypoglycaemia in people with a genetic predisposition

Clinical scoring systems for the risk of cardiovascular autonomic neuropathy in type 1 and type 2 diabetes: A simple tool.

This study was aimed at developing a clinical risk score for cardiovascular autonomic neuropathy (CAN) for type 1 and type 2 diabetes. In a retrospective cross-sectional one-centre study in an unselected population, 115 participants with type 1 diabetes (age 41.1 ± 12.2 years) and 161 with type 2 diabetes (age 63.1 ± 8.9 years), wellcharacterized for clinical variables, underwent standard cardiovascular reflex tests (CARTs). Strength of associations of confirmed CAN (based on 2 abnormal CARTs) with clinical variables was used to build a CAN risk score. CAN risk score was based on resting heart rate, HbA1c, retinopathy, nephropathy, cardiovascular disease in both type 1 and type 2 diabetes, and on HDL cholesterol, systolic blood pressure, and smoking in type 1 diabetes or insulin treatment and physical activity in type 2 diabetes (range 0-10). In type 1 diabetes, CAN risk score showed an area under the ROC curve (AUC) of 0.890 ± 0.034, and at cut-off of 4 sensitivity of 88%, specificity of 74.4%, and negative predictive value (NPV) of 95.7% for confirmed CAN. In type 2 diabetes, CAN risk score showed an AUC of 0.830 ± 0.051 and at the cut-off of 4 sensitivity and specificity of 78.6% and 73.5%, respectively, and NPV of 97.3% for confirmed CAN. These newly developed CAN risk scores are accessible in clinical practice and, if confirmed in a validation study, they might identify asymptomatic individuals with diabetes at greater risk of CAN to be referred to CARTs, thus limiting the burden of a universal screening

Terapia combinata con fotodinamica-verterporfirina e ranibizumab intravitreale per il trattamento della Retinal Angiomatous Proliferation correlata alla degenerazione maculare senile.

Purpose : to evaluate the efficacy and safety of the combination of Photodynamic Therapy (PDT) with standard fluence verteporfin and Ranibizumab 0.5mg administered on the same day, in patients with the neovascolar AMD (Aged Macular Degeneration) known as RAP (Retinal angiomatous proliferation ). Type of study : open-label, monocentric, randomized case series trial. Methods: 6 eyes of 6 patients were consecutively enrolled and treated with combined therapy defined as standard fluence PDT and intravitreal Ranibizumab 0.5mg on the same day. More injection were administrated as needed.Best corrected visual acuity (BCVA), central macular thickness (CMT) on optical coherence tomography (OCT) and Fluorescein angiography (FA) were examined before and after treatment every 4 weeks. Patients were followed-up for twelve months. Results: the mean baseline BCVA (± standard deviation, SD) was 27,8 (LogMar 0,576)(±14,6) (p=), at 12 months after treatment mean BCVA was 33,3 (LogMar 0,466 )(±16,6) (p=). The mean CMT at baseline was 393,8µm (±82,4) (p=) at 12 months was 250,7 µm (±82,4) (p=). The mean reduction was 142,2 µm. At 12 months in 4 eyes (66,6%) there was the absence of leakage on FA . After 12 months, the rate of retreated eyes was 33,3 % (2 of 6 eyes). Discussion and Conclusion: In conclusion the treatment shows a functional and anatomical improvement since the first month after treatment. OCT shows this improvement as a great reduction of intraretinal edema. No ocular or systemic adverse effects from treatment were encountered

Clinical scoring systems for the risk of cardiovascular autonomic neuropathy in type 1 and type 2 diabetes: A simple tool

This study was aimed at developing a clinical risk score for cardiovascular autonomic neuropathy (CAN) for type 1 and type 2 diabetes. In a retrospective cross-sectional one-centre study in an unselected population, 115 participants with type 1 diabetes (age 41.1 +/- 12.2 years) and 161 with type 2 diabetes (age 63.1 +/- 8.9 years), well-characterized for clinical variables, underwent standard cardiovascular reflex tests (CARTs). Strength of associations of confirmed CAN (based on 2 abnormal CARTs) with clinical variables was used to build a CAN risk score. CAN risk score was based on resting heart rate, HbA1c, retinopathy, nephropathy, cardiovascular disease in both type 1 and type 2 diabetes, and on HDL cholesterol, systolic blood pressure, and smoking in type 1 diabetes or insulin treatment and physical activity in type 2 diabetes (range 0-10). In type 1 diabetes, CAN risk score showed an area under the ROC curve (AUC) of 0.890 +/- 0.034, and at cut-off of 4 sensitivity of 88%, specificity of 74.4%, and negative predictive value (NPV) of 95.7% for confirmed CAN. In type 2 diabetes, CAN risk score showed an AUC of 0.830 +/- 0.051 and at the cut-off of 4 sensitivity and specificity of 78.6% and 73.5%, respectively, and NPV of 97.3% for confirmed CAN. These newly developed CAN risk scores are accessible in clinical practice and, if confirmed in a validation study, they might identify asymptomatic individuals with diabetes at greater risk of CAN to be referred to CARTs, thus limiting the burden of a universal screening