A performance score of the quality of inpatient diabetes care is a marker of clinical outcomes and suggests a cause-effect relationship between hypoglycaemia and the risk of in-hospital mortality

Aims: To build a tool to assess the management of inpatients with diabetes mellitus and to investigate its relationship, if any, with clinical outcomes. Materials and methods: A total of 678 patients from different settings, Internal Medicine (IMU, n = 255), General Surgery (GSU, n = 230) and Intensive Care (ICU, n = 193) Units, were enrolled. A work-flow of clinical care of diabetes was created according to guidelines. The workflow was divided into five different domains: (a) initial assessment; (b) glucose monitoring; (c) medical therapy; (d) consultancies; (e) discharge. Each domain was assessed by a performance score (PS), computed as the sum of the scores achieved in a set of indicators of clinical appropriateness, management and patient empowerment. Appropriate glucose goals were included as intermediate phenotypes. Clinical outcomes included: hypoglycaemia, survival rate and clinical conditions at discharge. Results: The total PS and those of initial assessment and glucose monitoring were significantly lower in GSU with respect to IMU and ICU (P <.0001). The glucose monitoring PS was associated with lower risk of hypoglycaemia (OR = 0.55; P <.0001), whereas both the PSs of glucose monitoring and medical therapy resulted associated with higher in-hospital survival only in the IMU ward (OR = 6.67 P =.001 and OR = 2.38 P =.03, respectively). Instrumental variable analysis with the aid of PS of glucose monitoring showed that hypoglycaemia may play a causal role in in-hospital mortality (P =.04). Conclusions: The quality of in-hospital care of diabetes may affect patient outcomes, including glucose control and the risk of hypoglycaemia, and through the latter it may influence the risk of in-hospital mortality

Relationship of Insulin Resistance and Related Metabolic Variables to Coronary Artery Disease: A Mathematical Analysis

OBJECTIVE—People with diabetes have an increased risk of coronary artery disease (CAD). An unanswered question is what portion of CAD can be attributed to insulin resistance, related metabolic variables, and other known CAD risk factors

Impairments in Site-Specific AS160 Phosphorylation and Effects of Exercise Training

The purpose of this study was to determine if site-specific phosphorylation at the level of Akt substrate of 160 kDa (AS160) is altered in skeletal muscle from sedentary humans across a wide range of the adult life span (18–84 years of age) and if endurance- and/or strength-oriented exercise training could rescue decrements in insulin action and skeletal muscle AS160 phosphorylation. A euglycemic-hyperinsulinemic clamp and skeletal muscle biopsies were performed in 73 individuals encompassing a wide age range (18–84 years of age), and insulin-stimulated AS160 phosphorylation was determined. Decrements in whole-body insulin action were associated with impairments in insulin-induced phosphorylation of skeletal muscle AS160 on sites Ser-588, Thr-642, Ser-666, and phospho-Akt substrate, but not Ser-318 or Ser-751. Twelve weeks of endurance- or strength-oriented exercise training increased whole-body insulin action and reversed impairments in AS160 phosphorylation evident in insulin-resistant aged individuals. These findings suggest that a dampening of insulin-induced phosphorylation of AS160 on specific sites in skeletal muscle contributes to the insulin resistance evident in a sedentary aging population and that exercise training is an effective intervention for treating these impairments

Evidenze di un possibile trattamento chirurgico in uno scheletro del sepolcreto di Casal Bertone (Roma, I-III sec. d.C.)

Nel corso dello scavo di Casal Bertone, che ha restituito oltre 200 sepolture è stato rinvenuto un individuo con evidenti alterazioni dei piedi. Le ossa tarsali risultavano fuse, i metatarsali avevano epifisi sfrangiate e cavità pseudocistiche e la tuberosità del calcagno destro era attraversata da un foro di dubbia eziologia. L’ individuo, d’età alla morte compresa tra 50 e 60 anni, di sesso femminile, è di corporatura gracile con una statura pari a 147 cm ca. Al fine di comprendere la patologia che aveva colpito l’individuo e la natura del foro del calcagno, gli elementi dei piedi sono stati sottoposti ad indagine tramite tomografia assiale computerizzata (TAC). Dalle immagini ottenute si osserva che la zona adiacente al foro presenta una radiopacità molto elevata dovuta alla calcificazione dell’osso; tale dettaglio suggerisce che il foro sia stato praticato in vita. L’ipotesi di un possibile intervento chirurgico potrebbe essere avvalorata dal rinvenimento di tracce d’argento all’interno del foro. Le fonti storiche riportano che alcuni strumenti chirurgici e contenitori utilizzati per miscelare i farmaci potevano esserne rivestiti; inoltre in età imperiale è attestato l’utilizzo dell’argento nelle ricette, come componente di farmaci e impiastri per il trattamento di alcune patologie.During the excavation of Casal Bertone an individual was found with evident alterations of the feet. The tarsal bones were fused, the metatarsals had fringed epiphysis and pseudocyst cavities and the tuberosity of the right calcane was crossed by a hole of dubious etiology. The individual, aged between 50 and 60 years old, of a female gender, is of a gracile body with a height of about 147 cm. ..............

Prevalence of hyperuricemia and relation of serum uric acid with cardiovascular risk factors in a developing country

BACKGROUND: The prevalence of hyperuricemia has rarely been investigated in developing countries. The purpose of the present study was to investigate the prevalence of hyperuricemia and the association between uric acid levels and the various cardiovascular risk factors in a developing country with high average blood pressures (the Seychelles, Indian Ocean, population mainly of African origin). METHODS: This cross-sectional health examination survey was based on a population random sample from the Seychelles. It included 1011 subjects aged 25 to 64 years. Blood pressure (BP), body mass index (BMI), waist circumference, waist-to-hip ratio, total and HDL cholesterol, serum triglycerides and serum uric acid were measured. Data were analyzed using scatterplot smoothing techniques and gender-specific linear regression models. RESULTS: The prevalence of a serum uric acid level >420 μmol/L in men was 35.2% and the prevalence of a serum uric acid level >360 μmol/L was 8.7% in women. Serum uric acid was strongly related to serum triglycerides in men as well as in women (r = 0.73 in men and r = 0.59 in women, p < 0.001). Uric acid levels were also significantly associated but to a lesser degree with age, BMI, blood pressure, alcohol and the use of antihypertensive therapy. In a regression model, triglycerides, age, BMI, antihypertensive therapy and alcohol consumption accounted for about 50% (R2) of the serum uric acid variations in men as well as in women. CONCLUSIONS: This study shows that the prevalence of hyperuricemia can be high in a developing country such as the Seychelles. Besides alcohol consumption and the use of antihypertensive therapy, mainly diuretics, serum uric acid is markedly associated with parameters of the metabolic syndrome, in particular serum triglycerides. Considering the growing incidence of obesity and metabolic syndrome worldwide and the potential link between hyperuricemia and cardiovascular complications, more emphasis should be put on the evolving prevalence of hyperuricemia in developing countries

Effect of sitagliptin on cardiovascular outcomes in type 2 diabetes

BACKGROUND: Data are lacking on the long-term effect on cardiovascular events of adding sitagliptin, a dipeptidyl peptidase 4 inhibitor, to usual care in patients with type 2 diabetes and cardiovascular disease. METHODS: In this randomized, double-blind study, we assigned 14,671 patients to add either sitagliptin or placebo to their existing therapy. Open-label use of antihyperglycemic therapy was encouraged as required, aimed at reaching individually appropriate glycemic targets in all patients. To determine whether sitagliptin was noninferior to placebo, we used a relative risk of 1.3 as the marginal upper boundary. The primary cardiovascular outcome was a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for unstable angina. RESULTS: During a median follow-up of 3.0 years, there was a small difference in glycated hemoglobin levels (least-squares mean difference for sitagliptin vs. placebo, -0.29 percentage points; 95% confidence interval [CI], -0.32 to -0.27). Overall, the primary outcome occurred in 839 patients in the sitagliptin group (11.4%; 4.06 per 100 person-years) and 851 patients in the placebo group (11.6%; 4.17 per 100 person-years). Sitagliptin was noninferior to placebo for the primary composite cardiovascular outcome (hazard ratio, 0.98; 95% CI, 0.88 to 1.09; P<0.001). Rates of hospitalization for heart failure did not differ between the two groups (hazard ratio, 1.00; 95% CI, 0.83 to 1.20; P = 0.98). There were no significant between-group differences in rates of acute pancreatitis (P = 0.07) or pancreatic cancer (P = 0.32). CONCLUSIONS: Among patients with type 2 diabetes and established cardiovascular disease, adding sitagliptin to usual care did not appear to increase the risk of major adverse cardiovascular events, hospitalization for heart failure, or other adverse events

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 &lt; 60 mL/min/1.73 m2) or eGFR reduction &gt; 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 &lt; 90 ml/min/m2 were independent risk factors for stage 653 CKD and renal function worsening. When compared to patients with eGFR &gt; 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

Infantile post-traumatic feeding disorder and infantile anorexia: A clinical evaluation on maternal and child psychopathological risk factors

Introduction: The Post-traumatic Feeding Disorder has been introduced to define clinical evidence characterized by intense anticipatory anxiety of the child at the sight of food and great distress if the child is encouraged to eat by the caregiver; these children often show clinical history of actual unpleasant events namely of highly food or oral traumatic experiences due to medical treatments. Objective: To identify variables and interactive features of the maternal and child psychological profile in the context of some types of feeding disorders: Post-Traumatic Feeding Disorder, Infantile Anorexia and Food Sensory Aversions. Methodology: Sample: The sample consisted of 80 mother-infant dyads (age range of children: 17-36 months). Tools and procedures: Observing mother-child interaction during feeding was assessed using the following coding systems: Feeding Scale and Feeding Resistance Scale. The mother's psychological profile was assessed through the Psychiatric Symptom Checklist and Eating Attitude Test. The psychological profile of the child was assessed by the Child Behavior Checklist 1 ½-5. Results: Interactive variables: There were significant differences between all clinical groups examined and the control group to scores of Feeding Scale. In particular, children with Posttraumatic Feeding Disorder obtained higher average scores in all dimensions of Feeding Resistance Scale. Risk indicators in the psychological functioning of mothers: mothers of children with Post-traumatic Eating Disorder get average scores higher anxiety than mothers of children with Infantile Anorexia. Risk indicators in the psychological functioning of children: Children with Post-traumatic Feeding Disorder obtained higher average scores in Externalizing syndromes (aggressive behavior) than other clinical groups and control. Discussion and Conclusions: The results of our study confirm the specific clinical features of emotional dysregulation in children with Post-traumatic Feeding Disorder and the interconnections between psychological of mothers' and children's profile