Evaluation of a large set of patients with Autoimmune Polyglandular Syndrome from a single reference centre in context of different classifications

Purpose: To characterize patients with APS and to propose a new approach for their follow-up. Query ID="Q1" Text="Please check the given names and familynames." Methods: Monocentric observational retrospective study enrolling patients referred to the Outpatients clinic of the Units of Endocrinology, Diabetology, Gastroenterology, Rheumatology and Clinical Immunology of our Hospital for Autoimmune diseases. Results: Among 9852 patients, 1174 (11.9%) [869 (73.9%) female] were diagnosed with APS. In 254 subjects, the diagnosis was made at first clinical evaluation (Group 1), all the other patients were diagnosed with a mean latency of 11.3 ± 10.6 years (Group 2). Group 1 and 2 were comparable for age at diagnosis (35.7 ± 16.3 vs. 40.4 ± 16.6 yrs, p =.698), but different in male/female ratio (81/173 vs 226/696, p =.019). In Group 2, 50% of patients developed the syndrome within 8 years of follow-up. A significant difference was found after subdividing the first clinical manifestation into the different outpatient clinic to which they referred (8.7 ± 8.0 vs. 13.4 ± 11.6 vs. 19.8 ± 8.7 vs. 7.4 ± 8.1 for endocrine, diabetic, rheumatologic, and gastroenterological diseases, respectively, p <.001). Conclusions: We described a large series of patients affected by APS according to splitters and lumpers. We propose a flowchart tailored for each specialist outpatient clinic taking care of the patients. Finally, we recommend regular reproductive system assessment due to the non-negligible risk of developing premature ovarian failure

A mathematical model for the burden of diabetes and its complications

BACKGROUND: The incidence and prevalence of diabetes are increasing all over the world. Complications of diabetes constitute a burden for the individuals and the whole society. METHODS: In the present paper, ordinary differential equations and numerical approximations are used to monitor the size of populations of diabetes with and without complications. RESULTS: Different scenarios are discussed according to a set of parameters and the dynamical evolution of the population from the stage of diabetes to the stage of diabetes with complications is clearly illustrated. CONCLUSIONS: The model shows how efficient and cost-effective strategies can be obtained by acting on diabetes incidence and/or controlling the evolution to the stage of complications

Is it worth treating fever in intensive care unit patients? Preliminary results from a randomized trial of the effect of external cooling.

BACKGROUND: Antipyresis is a common clinical practice in intensive care, although it is unknown if fever is harmful, beneficial, or a negligible adverse effect of infection and inflammation. METHODS: In a randomized study, rectal temperature and discomfort were assessed in 38 surgical intensive care unit patients without neurotrauma or severe hypoxemia and with fever (temperature &gt;/=38.5 degrees C) and systemic inflammatory response syndrome. Eighteen patients received external cooling while 20 received no antipyretic treatment. RESULTS: Temperature and discomfort decreased similarly in both groups after 24 hours. No significant differences in recurrence of fever, incidence of infection, antibiotic therapy, intensive care unit and hospital length of stay, or mortality were noted between the groups. CONCLUSIONS: These results suggest that the systematic suppression of fever may not be useful in patients without severe cranial trauma or significant hypoxemia. Letting fever take its natural course does not seem to harm patients with systemic inflammatory response syndrome or influence the discomfort level and may save costs

Abdominal obesity and subclinical vascular damage in the elderly.

Objective The aim of the present study was to assess the relationships between metabolic syndrome, its components and arterial stiffness as well as evaluate the waist measurement that would accurately identify subclinical vascular damage. Methods Ninety-one participants (16 men) free of cardiovascular diseases with mean age 68.5W5.1 (range 60\u201380 years) and a BMI of 27.73W3.89 were included in the study. In each participant, we evaluated BMI, waist circumference, SBP and DBP, fasting glucose, cholesterol, low-density lipoprotein and high-density lipoprotein cholesterol, triglycerides and body composition by dual energy X-ray absorptiometry. Arterial stiffness was assessed by carotid-femoral and carotid-radial pulse wave velocity. We defined subclinical vascular damage as pulse wave velocity higher than 12 m/s. Metabolic syndrome was defined using both International Diabetes Federation (IDF) and National Cholesterol Education Program (NCEP) criteria. Results Significant associations were observed between age, triglycerides, waist circumference, trunk fat, SBP and DBP and carotid-femoral pulse wave velocity. Carotidfemoral pulse wave velocity but not carotid-radial pulse wave velocity was significantly higher in patients with metabolic syndrome than in those without metabolic syndrome, independently of its definition (IDF or NCEP). By using waist circumference cut-off suggested by IDF, it was possible to recognize a higher percentage of patients with subclinical vascular damage than by using those suggested by NCEP (88.5 vs. 50%, PU0.01 and 0.35, respectively). Conclusion These data show that in apparently healthy elderly, metabolic syndrome is strongly associated with subclinical vascular damage. Abdominal obesity and hypertriglyceridemia are also significant predictors of vascular damage. More conservative values of waist cut-off, as suggested by IDF, seem to be able to identify a larger group of patients with subclinical vascular damage, who should be better taken in consideration for treatment