Diabetic Nephropathy and COVID-19: The Potential Role of Immune Actors.

Nowadays, type II diabetes mellitus, more specifically ensuing diabetic nephropathy, and severe COVID-19 disease are known to be closely associated. The exact mechanisms behind this association are less known. An implication for the angiotensin-converting enzyme 2 remains controversial. Some researchers have started looking into other potential actors, such as neuropilin-1, mitochondrial glutathione, vitamin D, and DPP4. In particular, neuropilin-1 seems to play an important role in the underlying mechanism linking COVID-19 and diabetic nephropathy. We suggest, based on the findings in this review, that its up-regulation in the diabetic kidney facilitates viral entry in this tissue, and that the engagement of both processes leads to a depletion of neuropilin-1, which was demonstrated to be strongly associated with the pathogenesis of DN. More studies are needed to confirm this hypothesis, and research should be directed towards elucidating the potential roles of all these suggested actors and eventually discovering new therapeutic strategies that could reduce the burden of COVID-19 in patients with diabetic nephropathy.

Immune Checkpoint Inhibitor-Induced Diabetes Mellitus: Potential Role of T Cells in the Underlying Mechanism.

Immunotherapy is now a recognized treatment option for several types of cancer. However, some cancer patients treated with immune checkpoint inhibitors (ICIs) are subject to immune-related adverse events, including induced diabetes mellitus. The exact role and molecular/genetic action of ICIs in diabetes are still not well understood. Elucidating the underlying mechanisms in a proper fashion would allow better refining of biomarkers that would help diagnose patients at risk of altered immune system homeostasis, but would also hold the potential of new therapeutic options for diabetes. In the present narrative review, we propose to discuss the case of autoimmune diabetes following treatment with ICIs and the role of ICIs in the pathophysiology of diabetes. We also present some scarce available data on interesting potential immune therapies for diabetes.

Uncovering Demographic, Clinical, Triggering Factors Similarities Between Migraine and Irritable Bowel Syndrome: A Prospective Study.

The objective was to uncover demographical and clinical factors associated with migraine and irritable bowel syndrome (IBS) in a group of patients experiencing both painful disorders and to identify their triggering factors. A prospective study was performed between January 2016 and June 2017. Clinical characteristics and potential generating factors for both pathologies were then assessed using validated questionnaires. Our study showed that the percentage of patients diagnosed with migraine and having IBS was 34.3%. Compared with patients with migraine alone, patients having both diseases were identified with higher prevalence of concomitant chronic/psychiatric diseases, lower frequency of migraine attacks, and lower prevalence of throbbing/distressing/enervating pain and concentration difficulties than patients with migraine alone. Moreover, patients in this subgroup had moderate abdominal pain intensity, and constipation was the predominant stool type. Finally, some dietary and environmental factors seem to be significantly important triggering factors of migraine/IBS pain.

Validation of the Arabic Version of the Migraine Disability Assessment Scale Among Lebanese Patients with Migraine.

AIMS: To validate the Arabic version of the Migraine Disability Assessment Scale (MIDAS) and to evaluate the impact of the most frequently studied risk factors for migraine disability on the total MIDAS score in a Lebanese population. METHODS: This prospective study was performed from January 2017 to May 2017 and included 44 patients with migraine. Data were obtained using a questionnaire identifying sociodemographic characteristics, medical history, and migraine characteristics. The Arabic MIDAS was used to quantify the disability associated with headaches over a 3-month period. Ten days after completing the MIDAS, the participants were interviewed again to assess test-retest reproducibility. The validity of the MIDAS construct in the Lebanese population was confirmed by carrying out factor analyses for all the items of the questionnaire using the principal component analysis technique with a promax rotation. RESULTS: The MIDAS items converged over a solution of one factor that had an eigenvalue > 1, explaining a total of 63.25% of the variance (Cronbach's alpha = 0.812). Photophobia, vomiting, and duration of migraine attack of 24 to 48 hours significantly increased the MIDAS score by 21.396, 22.0, and 17.396 points, respectively, whereas a high socioeconomic level significantly decreased the MIDAS score by 6.837 points. CONCLUSION: This first linguistically validated Arabic version of the MIDAS was developed to improve migraine management in Arabic-speaking patients. Moreover, the results suggest that having longer migraine duration, more accompanying symptoms, and a low socioeconomic level can increase the MIDAS score and thus the level of disability.

Lethal hepatotoxicity following 5-fluorouracil/cisplatin chemotherapy: a relevant case report.

Some articles have reported severe toxicities induced by cisplatin/5-fluorouracil regimens, nevertheless, severe and lethal liver toxicity has not been previously reported. In this article, we report the case of a 72-year-old woman, who developed fulminant hepatitis, hypoglycemia and hypotension with atrial fibrillation not responding to treatment. After ruling out all other possible causes of hepatitis, the toxicity was more likely attributed to 5-fluorouracil. Genotyping was performed and the patient was found to be a homozygote carrier of the T variant of the MTHFR gene. The patient died two days later. Several factors, including genetic factors, could explain this severe toxicity. The present case discusses the importance of personalized medicine in oncology based on pharmacogenetic analysis of polymorphisms.