Elisa Misurati

All-cause mortality and estimated renal function in type 2 diabetes mellitus outpatients: Is there a relationship with the equation used?

Background: We investigated the relationship between serum creatinine (SCr) and estimated glomerular filtration rate (eGFR), evaluated by different formulae, and all-cause mortality (ACM) in type 2 diabetes mellitus (T2DM) outpatients. Methods: This observational cohort study considered 1365 T2DM outpatients, who had been followed up for a period of up to 11 years. eGFR was estimated using several equations. Results: Seventy subjects (5.1%) died after a follow-up of 9.8 ± 3 years. Univariate analysis showed that diagnosis of nephropathy (odds ratio (OR): 2.554, 95% confidence interval (CI): 1.616–4.038, p < 0.001) and microvascular complications (OR: 2.281, 95% CI: 1.449–3.593, p < 0.001) were associated with ACM. Receiving operating characteristic (ROC) curves showed that the areas under the curve for ACM were similar using the different eGFR equations. eGFR values were predictors of ACM, and the hazard ratios (HRs) of the different equations for eGFR estimation were similar. Conclusion: In our cohort of T2DM outpatients, different eGFR equations perform similarly in predicting ACM, whereas SCr did not.

Takotsubo cardiomyopathy and acute infectious diseases: a mini-review of case reports.

Takotsubo cardiomyopathy (TTC), also defined as “stress cardiomyopathy,” is characterized by a systolic dysfunction localized in the apical and medial left ventricles. Takotsubo cardiomyopathy is more prevalent in females and it is usually related to an event triggered by physical or emotional stress. We systematically explored PubMed and Embase medical information source to identify case reports showing association between infection and TTC. For each kind of infection, we collected a set of data, including pathogen, site of infection, clinical outcome, patient age and sex, and author and year of publication. We found 26 articles dealing with 27 case reports (74% women). The mean age was 61.4 ± 13.7 years and bacterial infections were more frequent (n = 23, 85.2%). In 14 cases, there was a culture-based definition of the bacterial strain: gram+ in 8 cases (57.1%) and gram− in 6 cases (42.9%). Clinical outcome was always favorable.

Pulmonary embolism and internal jugular vein thrombosis as evocative clues of Lemierre’s syndrome: A case report and review of the literature

Lemierre’s syndrome (LS) is an uncommon condition with oropharyngeal infections, internal jugular vein thrombosis, and systemic metastatic septic embolization as the main features. Fusobacterium species, a group of strictly anaerobic Gram negative rod shaped bacteria, are advocated to be the main pathogen involved. We report a case of LS complicated by pulmonary embolism and pulmonary septic emboli that mimicked a neoplastic lung condition. A Medline search revealed 173 case reports of LS associated with internal jugular vein thrombosis that documented the type of microorganism. Data confirmed high prevalence in young males with Gram negative infections (83.2%). Pulmonary embolism was reported in 8.7% of cases mainly described in subjects with Gram positive infections (OR = 9.786; 95%CI: 2.577-37.168, P = 0.001), independently of age and gender. Only four fatal cases were reported. LS is an uncommon condition that could be complicated by pulmonary embolism, especially in subjects with Gram positive infections.

Severe Acute Leukopenia Due to Candida Parapsilosis in an Old Comorbid Woman: A Case Report

depend directly on muscle size or strength. Removing balance from the questionnaire significantly improved the reliability test (Table 1). Gait speed, which had a correlation of 0.90, and the chair test, with a correlation of 0.84, explained total SPPB score. Together, these data suggest that the independent analysis of the SPPB provides the most reliable results and best explains the biological phenomenon of sarcopenia. Linear regression analysis was performed to compare the correlation between muscle volume and electrical muscle fatigue with the two more reliable items in the SPPB (walking speed and chair test). No correlation with walking speed (adjusted coefficient of determination (r) = 0.249, P = .22) or with the ability to rise from a chair (adjusted r = 0.286, P = .08) was observed, indicating that muscle volume does not affect muscular performance. Electromyographic analysis after fatigue clearly explains walking speed (adjusted r = 0.399, P = .05) and chair tests (adjusted r = 0.621, P = .001), indicating that muscle fatigue is an important phenomenon that explains the physical performance of elderly adults regardless of muscle volume. These results show that volume and strength are not related to SPPB scores but are directly correlated with changes in the fatigue-related electrical activity of the muscle. Gait speed and chair test performance were correlated with the number of motor units after exercise, when muscle fatigue was observed, suggesting that muscle fatigue is a phenomenon associated with effort, regardless of sex or age differences and supporting the hypothesis that muscle fatigue, as reflected by contractile function, is a crucial element in the assessment of sarcopenia in the elderly population. Differences were observed in muscle volume between men and women, whereas functionality was similar between the two sexes (Table 1). This observation indicates that muscle function is not related to muscle volume. Diagnostic criteria should be reconsidered and include electrical activity and muscle fatigue as early markers of muscle contractile degeneration.

Lumbar Pain As Unusual Presentation of Bone Marrow Metastatic Replacement by Colon Carcinoma

of 9 medication classes on falls in elderly persons. Arch Intern Med 2009;169:1952–1960. 3. Tromp AM, Pluijm SM, Smit JH et al. Fall-risk screening test: A prospective study on predictors for falls in community-dwelling elderly. J Clin Epidemiol 2001;54:837–844. 4. Foley AL, Loharuka S, Barrett JA et al. Association between the geriatric giants of urinary incontinence and falls in older people using data from the Leicestershire MRC Incontinence Study. Age Ageing 2012;41:35–40. 5. Tannenbaum C, Martin P, Tamblyn R et al. Reduction of inappropriate benzodiazepine prescriptions among older adults through direct patient education: The EMPOWER cluster randomized trial. JAMA Intern Med 2014;174:890–898. 6. Avery K, Donovan J, Peters TJ et al. ICIQ: A brief and robust measure for evaluating the symptoms and impact of urinary incontinence. Neurourol Urodyn 2004;23:322–330. 7. Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med 1988;319:1701–1707. 8. Todd C, Skelton D. What are the Main Risk Factors for Falls Amongst Older People and What Are the Most Effective Interventions to Prevent These Falls? Geneva, Switzerland: World Health Organization, 2004. 9. Gibson W, Wagg A. New horizons: Urinary incontinence in older people. Age Ageing 2014;43:157–163. 10. Kuo H-K, Lipsitz LA. Cerebral white matter changes and geriatric syndromes: Is there a link? J Gerontol A Biol Sci Med Sci 2004;59A:M818– M826.