A 70-year-old man, with an untreated and histologically undefined (of his own free will) lung cancer (diagnosed 5 years before) was admitted to our ambulatory for increasing dyspnoea and progressive exercise intolerance. Apical four-chamber echocardiographic findings (panel A) were …

Aim of this study is to evaluate any differences in VWF antigen, VWF activity and ADAMTS-13 activity before and after successful and non-successful Percutaneous Transluminal Angioplasty (PTA) in subjects with type 2 diabetes (T2DM) complicated by Chronic limb-threatening ischemia (CLTI) in diabetic foot vasculopathy.Methods: In this prospective observational pilot study, we enrolled 35 T2DM subjects who underwent lower limb PTA. Transcutaneous oximetry was performed in all patients before and 6 weeks after PTA. The change in oxygen partial pressure (TcpO2) before and after PTA was expressed as TcpO2-delta (aTcpO2). VWF antigen, VWF activity and ADAMTS-13 activity were measured before and 6 weeks after PTA; changes were expressed as delta and ratio from baseline. Results: Subjects with aTcpO2 < 15 mmHg presented higher aVWF activity (p = 0.050) and lower ADAMTS-13 activity ratio (p = 0.080). Subjects with aTcpO2 < 30 mmHg showed lower ADAMTS-13 activity a and ratio (p = 0.028).Conclusions: VWF antigen levels and VWF activity may potentially affect PTA outcome. Higher levels of VWF could derive from VWF release as consequence of PTA-induced mechanical endothelial damage and/or oxidative stress-induced modifications of VWF structure with impairment of VWF-ADAMTS13 interactions.

In this work, we will investigate if red blood cell (RBC) membrane fluidity, influenced by several hyperglycemia-induced pathways, could provide a complementary index of HbA1c to monitor the development of type 2 diabetes mellitus (T2DM)-related macroangiopathic complications such as Peripheral Artery Disease (PAD). The contextual liquid crystalline (LC) domain spatial organization in the membrane was analysed to investigate the phase dynamics of the transition. Twenty-seven patients with long-duration T2DM were recruited and classified in DM, including 12 non-PAD patients, and DM + PAD, including 15 patients in any stage of PAD. Mean values of RBC generalized polarization (GP), representative of membrane fluidity, together with spatial organization of LC domains were compared between the two groups; p-values < 0.05 were considered statistically significant. Although comparable for anthropometric characteristics, duration of diabetes, and HbA1c, RBC membranes of PAD patients were found to be significantly more fluid (GP: 0.501 ± 0.026) than non-PAD patients (GP: 0.519 ± 0.007). These alterations were shown to be triggered by changes in both LC microdomain composition and distribution. We found a decrease in Feret diameter from 0.245 ± 0.281 μm in DM to 0.183 ± 0.124 μm in DM + PAD, and an increase in circularity. Altered RBC membrane fluidity is correlated to a spatial reconfiguration of LC domains, which, by possibly altering metabolic function, are associated with the development of T2DM-related macroangiopathic complications.

We report on the diagnosis of anomalous coronary artery in two brothers. Following the diagnosis of anomalous coronary artery in one sibling, we screened immediate family relatives and found the same anomaly in the older brother. Familiarity in this pathology is extremely rare. We analysed and compared clinical, echocardiographic and radiological findings in the two brothers.

Continuous glucose monitoring (CGM) might be an effective tool to improve glycemic control in gestational diabetes mellitus (GDM). Few data are available about its utilization as a diagnostic tool to find potential alterations of glycemia in subjects with normal oral glucose tolerance test (OGTT). In this preliminary prospective real-life observational study, we aimed to analyze the glycemic pattern in normal and gestational diabetes mellitus (GDM) women by continuous glucose monitoring (CGM) in order to detect potential differences between the two groups and glycemic alterations despite a normal OGTT. After the screening for GDM, subjects were connected to a CGM system for seven consecutive days. The areas under the curve of the first 60 minutes after each meal and 60 minutes before breakfast were analyzed. Women with normal OGTT that during CGM showed impaired glycemic values (more than 95 fasting or more than 140 one hour after meals or more than 120 two hours after meals) performed one week of self-monitoring of blood glucose (SMBG). After OGTT, 53 women considered normal and 46 affected by GDM were included. CGM parameters did not show any differences between the two groups with impaired glycemic excursions found in both groups. After CGM period, 33 women with normal OGTT showed abnormal glycemic patterns. These 33 women then performed one week of SMBG. After evaluation of one week of SMBG, 21 required diet therapy and 12 required insulin treatment and were followed until the delivery. An increase in gestational weight gain was observed in normal women with normal OGTT but this was not significant. No significant data were found regarding neonatal outcomes in the two groups of women. In conclusion, CGM use in pregnancy might help to detect glycemic fluctuations in women with normal OGTT, improving their treatment and outcomes.

In a 6-year-old child patient, transthoracic echocardiography revealed a large saccular structure (with anechogenic content) in the left atrium, near the fossa ovalis, and diagnosis of the left atrial septal pouch was made. The left atrial septal pouch is a kangaroo pouch-like structure on the left side of the interatrial septum, opened into the left atrial cavity without a connection between the left and right atria. It occurs when the foramen ovale is absent but the septum primum and septum secundum are only partially fused. The left atrial septal pouch is believed to be present in 47% of population. In many cases, the pocket on the atrial septum is small and it could not be detected by transthoracic echocardiography. Our description is uncommon because we diagnosed a very large septal pouch. Based on our knowledge, this is the youngest reported case of the left atrial septal pouch and the longest follow-up described in this type of congenital heart malformation.

In 1591 Italian subjects affected by SARS-COV-2, there was a prevalence of 17% of type 2 diabetes [1Grasselli Giacomo Zangrillo Alberto Zanella Alberto Antonelli Massimo Cabrini Luca Castelli Antonio Cereda Danilo Coluccello Antonio Foti Giuseppe Fumagalli Roberto Iotti Giorgio Latronico Nicola Lorini Luca Merler Stefano Natalini Giuseppe Piatti Alessandra Ranieri Marco Vito Scandroglio Anna Mara Storti Enrico Cecconi Maurizio Pesenti Antonio Baseline characteristics and outcomes of 1591 patients infected With SARS-CoV-2 admitted to ICUs of the Lombardy Region, Italy.JAMA. 2020; 323: 1574https://doi.org/10.1001/jama.2020.5394Crossref PubMed Scopus (3885) Google Scholar]. In analogy to what has been shown in a Chinese population [2Wu Z. McGoogan Characteristic of and important lessons from the Coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72314 cases from the Chinese Center for Disease Control and Prevention.JAMA. 2020; https://doi.org/10.1001/jama.2020.2648Crossref Scopus (12777) Google Scholar] and in another group of Italian subjects [3Fadini G.P. Morieri M.L. Longato E. Avogaro A. Prevalence and impact of diabetes among people infected with SARS-CoV-2.J Endocrinol Invest. 2020; 43: 867-869https://doi.org/10.1007/s40618-020-01236-2Crossref PubMed Scopus (340) Google Scholar], surprisingly no cases with type 1 diabetes are apparently reported. This observation needs to be confirmed and further evaluated, for example in regions with high prevalence of the disease (Scandinavian, Finland or Sardinian), but there could be a number of reasons that justify a low incidence of SARS-COV-2 in subjects with type 1 diabetes. This result may be apparently linked to the younger age of type 1 diabetes subjects and the lower prevalence of the disease, if compared to type 2 diabetes in general population, but it could have some intriguing implications. Type 1 diabetes subjects, initially classified as a high-risk category in some countries as Italy, might have taken advantage of an early application of social distancing measures, such as smart working, indirectly supporting this kind of approach to reduce the prevalence and the negative outcomes of the infection. At the same time, from a pathophysiologycal point of view, type 1 diabetes is an autoimmune disorder characterized by a dysregulation of adaptative immunity with an overexpression of CD8+ T lymphocytes [4Pitocco D. Di Leo M. Tartaglione L. De Leva F. Petruzziello C. Saviano A. et al.The role of gut microbiota in mediating obesity and diabetes mellitus.Eur Rev Med Pharmacol Sci. 2020; 24: 1548-1562PubMed Google Scholar]. It is conceivable that this immunological attitude might play a protective role during SARS-COV2 infection, in which CD8+ T lymphocytes show an increased apoptosis resulting in lymphocytopenia. Indeed, we cannot rule out that there are some asymptomatic subjects with SARS-COV-2 infection in type 1 diabetic population. Finally, while the infected population has a high prevalence of hypertension, type 1 diabetes is often characterized by hyperglycemia in the absence of the other cardiovascular risk factors. It could mean and suggest that the metabolic disturbance per se is unrelated to the outcomes of this viral infection. All the authors have made substantive contributions to the article and assume full responsibility for its content. The authors did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Background: The diabetic Charcot foot syndrome is a serious and potentially limb-threatening lower-extremity complication of diabetes.Introduction: The present review provides a concise account of the advances made over the last twenty-five years in understanding the pathogenesis and management of Charcot neuroarthropathy (CN).Methods: In this study, the widely known pathogenetic mechanisms underpinning CN are brought into focus, particularly the role of RANKL/RANK/OPG system and advanced glycation end production in the pathogenesis of CN. Furthermore, other potential triggering factors, namely nitric oxide, endothelial dysfunction, macro calcifications and body weight that influence CN have also been discussed.Results: The wide range of diagnostic tools available to clinicians for accurate staging of this pathology has been examined, particularly radiological and nuclear medicine imaging. Additionally, the difficult differential diagnosis between osteomyelitis and CN is also elucidated.Conclusion: The review concludes with the comprehensive summary of the major promising therapeutic strategies, including conservative treatment involving orthopedic devices, pharmacological approach, and the most common surgical techniques currently employed in the diagnosis and treatment of this acute disease.

Diabetes could be a risk factor for severity and mortality in patients with coronavirus disease 2019 COVID-19. It has been hypothesized that DPP4 inhibition, a therapy currently available for type 2 diabetes, might represent a target for decreasing the risk of the acute respiratory complications of the COVID-19 infection but (1) lack of demonstration of SARS-CoV2 binding to DPP4 (2) possible protective role of sDPP4 in Middle East respiratory Syndrome (MERS-CoV) (3) demonstrated inhibition and downregulation of DPP4 by HIV1 and MERS-CoV and (4) not exclusive role of the receptor binding in tropism of the Coronavirus family, support that DPP4 inhibition at present doesn't represent a plausible approach to mitigate COVID-19.

Background: Diabetic Ketoacidosis (DKA) is one of the most commonly encountered diabetic complication emergencies. It typically affects people with type 1 diabetes at the onset of the disease. It can also affect people with type 2 diabetes, although this is uncommon.Methods: Research and online content related to diabetes online activity is reviewed. DKA is caused by a relative or absolute deficiency of insulin and elevated levels of counter-regulatory hormones.Results: Goals of therapy are to correct dehydration, acidosis, and to reverse ketosis, gradually restoring blood glucose concentration to near normal.Conclusion: It is essential to monitor potential complications of DKA and, if necessary, to treat them and any precipitating events.

Several drug classes are now available to achieve a satisfactory metabolic control in patients with type 2 diabetes (T2DM), but patients’ preferences may differ.

Charcot Neuro-arthropathy (CN) is a condition characterized by a progressive derangement of the joints, in individuals affected with sensitive and autonomic neuropathy. The pathogenesis of CN is multifactorial as neuropathy is a necessary, but insufficient condition for the onset of the disease. The most important indication for surgical treatment of Charcot foot is a severe deformity that compromises the functionality of the limb, causing a high risk for ulceration, infection and amputation. The goal in Charcot foot treatment is to obtain and maintain the correction of a severe deformity and/or prevent its development. There are many surgical approach to the CN, such as exostectomy, arthrodesis with internal or external fixation and amputation. Every method has a different indication and specific complication. The right surgical approach in the CN is a real challenge for orthopedic surgeon that need a complete knowing of technique, material and complication.

Diabetes mellitus is a syndrome characterized by a condition of chronic hyperglycemia that may be complicated by organ damage. In the age group ranging from 20 to 79 years the prevalence of the disease is around 9%. Compensated diabetes mellitus does not prevent the possibility of working and does not imply a reduction in work capacity. In case of acute manifestations, poor compensation or chronic complications such as retinopathy, nephropathy, neuropathy or cardiovascular disease, the assessment of fitness for work must be established according to the task and the psychophysical conditions of the worker in order to protect his health.

We performed 55 operations in 40 patients affected by diabetic foot and referred to the Diabetic Day Hospital from 1998 to 2003. Surgical procedures can be grouped as: (a) emergency operations: mos...

A congenital coronary artery fistula (CAF) is a rare form of heart disease in which a coronary artery and a cardiac chamber or another vascular structure communicate. CAF could worsen ventricular perfusion and function, favoring ventricular ischemia and arrhythmias. To our knowledge, this is the first report of CAF, draining in the pulmonary artery, in two asymptomatic dizygotic twin brothers, diagnosed by echocardiography. Dizygotic twins are siblings with different genes exposed to the same environmental experience during the pregnancy. The occurrence of CAF (with similar instrumental findings) in both twin brothers could depend on a poorly identified environmental factor during pregnancy.

OBJECTIVE:To investigate the effect of healthcare provider (HCP) type (primary vs. specialist) on glycaemic control and other treatment parameters. RESEARCH DESIGN AND METHODS:Study of Once-Daily Levemir (SOLVE(™) ) is an international, 24-week, observational study of insulin initiation in people with type 2 diabetes. RESULTS:A total of 17,374 subjects were included, comprising 4144 (23.9%) primary care subjects. Glycaemic control improved in both HCP groups from baseline to final visit [glycated haemoglobin (HbA1c) -1.2 ± 1.4% (-13.1 ± 15.3 mmol/mol) and -1.3 ± 1.6% (-14.2 ± 17.5 mmol/mol), respectively]. After adjustment for known confounders, there was no statistically significant effect of HCP group on final HbA1c [-0.04%, 95% confidence interval (CI) -0.09 to -0.01 (-0.4 mmol/mol, 95% CI -1.0-0.1 mmol/mol), p = 0.1590]. However, insulin doses at the final visit were higher in primary care patients (+0.06, 95% CI 0.06-0.07 U/kg, p < 0.0001). Logistic regression demonstrated a significant effect of HCP type (primary vs. specialist care) on hypoglycaemia risk [odds ratio (OR) 0.75, 95% CI 0.64-0.87, p = 0.0002]. Primary care physicians took more time to train patients and had more frequent contact with patients than specialists (both p < 0.0001). CONCLUSIONS:Primary care physicians and specialists achieved comparable improvements in glycaemic control following insulin initiation.

Aims Charcot neuroarthropathy (CN) is a disabling complication, culminating in bone destruction and involving joints and articular cartilage with high inflammatory environment. Its real pathogenesis is as yet unknown. In autoinflammatory diseases, such as rheumatoid arthritis, characterized by inflammation and joint involvement, autoantibodies against oxidative post-translationally modified (oxPTM) collagen type I (CI) and type II (CII) were detected. Therefore, the aim of our study was to assess the potential involvement of autoimmunity in charcot neuroarthropathy, investigating the presence of autoantibodies oxPTM-CI and oxPTM-CII, in participants with charcot neuroarthropathy.Methods In this case-control study, we enrolled 124 participants with type 2 diabetes mellitus (47 with charcot neuroarthropathy, 37 with diabetic peripheral neuropathy without charcot neuroarthropathy, and 40 with uncomplicated diabetes), and 32 healthy controls. The CI and CII were modified with ribose and other oxidant species, and the modifications were evaluated with sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Binding of sera from the participants was analyzed with enzyme-linked immunosorbent assay.Results Age, body mass index, waist and hip circumferences, and lipid profile were similar across the 4 groups, as well as glycated hemoglobin and duration of diabetes among people with diabetes. An increased binding to both native and all oxidation-modified forms of CII was found in participants with CN and diabetic neuropathy. Conversely, for CI, an aspecific increased reactivity was noted.Conclusions Our results detected the presence of autoantibodies against oxidative post-translational modified collagen, particularly type 2 collagen, in participants with charcot neuroarthropathy and diabetic neuropathy, suggesting the possible involvement of autoimmunity. Further studies are required to understand the role of autoimmunity in the pathogenesis of charcot neuroarthropathy.

The study aimed to evaluate the frequency of episodes of symptomatic hypoglycemia (SH) in elderly patients with type 2 diabetes and their impact on quality of life.