Osteoglycin (OGN) is a key modulator of the circuit among bone, pancreas, and hypothalamus, responsible for glucose homeostasis, bone formation, and energy balance. This study aimed to evaluate the association between serum OGN levels and diabetic nephropathy (DN), as well as to assess its potential as a biomarker for disease presence and severity. Additionally, it explored the utility of OGN as an early detection marker for DN in the Egyptian population. Four groups were enrolled in the study: Group I (control group) included 23 healthy subjects; Group II included 23 normoalbuminuric type 2 diabetic patients; Group III included 23 type 2 diabetic patients with microalbuminuria; and Group IV included 23 type 2 diabetic patients with macroalbuminuria. Laboratory investigations included fasting blood glucose (FBG), glycated hemoglobin (HbA1c), complete blood count (CBC), kidney function tests, liver function tests, and lipid profile. The estimated glomerular filtration rate (eGFR) was calculated. Serum C-peptide and OGN levels were determined using enzyme-linked immunosorbent assay (ELISA). Significantly lower OGN levels were detected in the control group and diabetic normoalbuminuric groups compared with micro- and macroalbuminuric diabetic patients (p<0.001 for each). Additionally, significantly higher OGN levels were detected among macroalbuminuric patients than diabetic patients with microalbuminuria (p=0.04). Moreover, there were statistically significant negative correlations between serum OGN and high-density lipoprotein-cholesterol (HDL-C), total protein, serum albumin, eGFR, and C-peptide. Furthermore, statistically significant positive correlations were detected between serum OGN and total cholestenol, triglycerides (TG), low-density lipoprotein-cholesterol (LDL-C), FBG, HbA1c, systolic blood pressure, creatinine, blood urea nitrogen (BUN), and albumin-creatinine ratio (ACR). HbA1c, LDL-C, ACR, BUN, and HDL independently correlated with serum OGN. Furthermore, serum OGN was a good predictor of macroalbuminuria with 87% sensitivity and specificity. It was also a good predictor of macroalbuminuria with 82.6% sensitivity and 78.3% specificity. In conclusion, serum OGN levels were significantly associated with markers of kidney function and protein levels in patients with type 2 diabetes mellitus (T2DM). Serum OGN served as a discriminatory biomarker for the early detection of DN with high sensitivity and specificity.
È dall'imbuto terminale del terzo millennio che emerge, tra le rovine di Nippur, una insolita tavoletta d'argilla. Misura appena 16 cm x 9 cm, e in essa son raccolte, da un anonimo medico, ricette a base di sostanze vegetali, animali, minerali: forse può essere considerata il piu antico manuale medico. E se medicina e legislazione professionale nelle lontanissime civilta mesopotamiche possedevano un estensione 'teurgica' (e la divinita che sancisce lo stato di salute o di malattia), il medico opera, di conseguenza, nella sua veste di sacerdote-mago. Egli non governa direttamente il paziente e la malattia, ma, da benevolo intermediario, dominato dal sovrannaturale, facilita il traghettare del paziente verso le sponde della illuminata lungimiranza divina, quindi verso uno stato di benessere, attraverso la conquista della salute, o, in parallelo, officiando il rito sacrificale. Più pragmatico appare Poperato del chirurgo. Armato del suo scudo laico, é schiavo operativo del medico-sacerdote. Su tale scenario la possanza evocativa degli interrogativi primordiali viene mirabilmente travasata dalla parola poetica. Nella Saga di Gilgamesh, poema epico-eroico precedente ai poemi omerici, l'eroe fa appello al dio Sole per favorire l'incontro con 11 mostro Khubaba, insormontabile guardiano della foresta di Cedri. Cosi scritto, nel grido dell'eroe posto alla conquista della morte
Background. Vaccination is still a key part of primary prevention, and it has led to big drops in illness, complications, and death, especially among people who are more likely to get sick. Patients affected by chronic conditions, immunocompromising disorders, or neoplastic diseases are disproportionately susceptible to vaccine-preventable infections and their severe complications, demonstrating the importance of immunization strategies in this cohort. Nevertheless, the delivery of vaccination in such patients is fraught with challenges, chiefly attributable to the paucity of harmonized guidelines and the fragmentation of existing recommendations, which collectively engender significant heterogeneity in clinical practice. The present study was undertaken to systematically consolidate prevailing vaccination recommendations from both national and international sources, with the aim of devising pragmatic, user-oriented instruments to support vaccination delivery within the Sicilian healthcare framework. Materials and Methods. A multidisciplinary panel, comprising senior medical officers, academic researchers, and postgraduate trainees in Hygiene and Preventive Medicine from the University of Palermo, conducted an exhaustive review of major reference sources, including the Red Book¹, the Italian National Vaccine Prevention Plan 2023–2025², the "Calendario per la Vita," and the regional immunization schedules of Sicily³ and Veneto. Specific recommendations were extrapolated for distinct pathological entities, socio-behavioral risk groups (e.g., men who have sex with men [MSM], incarcerated populations, and sex workers), and patients receiving immunosuppressive or immunomodulatory therapies. The extracted data were systematically collated and synthesized into (i) a comprehensive database cross-referencing recommended vaccines by underlying pathology or condition and (ii) condensed decision-support algorithms for the principal fragility profiles, encompassing states of immunosuppression and hematopoietic stem cell transplantation. The resultant frameworks were prospectively pilot-tested in the fragile patient population attending the Vaccination Outpatient Clinic of the University Hospital “Paolo Giaccone” in Palermo. Results. The systematic review and synthesis yielded two primary operational outputs: a set of illustrative flowcharts delineating vaccination indications by clinical scenario and a modular, patient-facing personalized vaccination schedule, concurrently designed for physician reference and patient education. Implementation of these instruments substantially streamlined vaccination pathway planning, enhanced the quality of provider-patient communication, expedited clinical decision-making, and facilitated more comprehensive patient assessment. Moreover, their adoption promoted greater consistency in immunization protocols across different clinical sites and practitioners, effectively attenuating unwarranted prescriptive variability. The personalized schedule, by affording a clear temporal visualization of the immunization trajectory, was instrumental in bolstering patient adherence and health literacy, demonstrating feasibility even within the constraints of complex, multidisciplinary care settings. Conclusions. In the absence of widely endorsed, evidence-based consensus guidelines, the proposed framework offers a pragmatic, scalable, and readily transferable operational model for optimizing vaccination management in fragile patients across the Sicilian Region. The systematic standardization of immunization schedules and the implementation of structured clinical decision-support tools have the potential to improve the appropriateness of vaccine administration, reduce unnecessary variations in practice, and increase the overall efficiency of the patient care pathway. Furthermore, drawing on real-world experience from one of the three Sicilian centers accredited with the three-seal certification by the Ospivax National Network, this model is poised for broader regional and national dissemination.
We describe a case of neonatal hyperinsulinism. A boy suffered from seizures due to hypoglicemia on 6 months after birth. Ammonia level, tested when he was one year old was slightly elevated. He is now ten years old and showed mild but persistent hyperammonemia and frequent hypoglicemia, but he never presented seizures since he was 10 months old. He has also been suffering from mild mental retardation.
In this work several complications related to mammary implants have been analyzed. These complications can be divided into different groups: local, systemic, immediate and long term. Particular attention has to be directed to the most important complications which are capsular contracture and implant rupture, with consequent new surgical intervention.
