Renal Vein Thrombosis Secondary to Pyelonephritis: Targeting a Thrombo-Inflammatory Entity.

Renal vein thrombosis (RVT) is a relatively uncommon condition that is most frequently observed in individuals with nephrotic syndrome. While rare, pyelonephritis (PN) may serve as a predisposing factor for secondary RVT. In such cases, one should consider the possibility of RVT when patients fail to respond to appropriate antibiotic treatment. Typically, these patients require additional anticoagulation therapy for a duration of 3 to 6 months, with a generally favorable prognosis. In this report, we present the case of a 74-year-old female who developed RVT due to Klebsiella pneumoniae PN. Additionally, we reviewed 11 cases of PN complicated by RVT, which were documented in the PubMed database over a span of 40 years, emphasizing key elements in diagnostic and therapeutic approaches. Lastly, we elaborated upon the role of thrombo-inflammation, especially in the context of sepsis.

Pneumocystosis in a patient with rheumatoid arthritis on adalimumab therapy: a case-based review.

Pneumocystis jirovecii pneumonia (PJP) is a potentially fatal type of pneumonitis, which may have devastating consequences. Typically, it occurs in immunocompromised patients, with the natural history varying depending on the presence or not of HIV infection. Staining and polymerase chain reaction (PCR) testing in induced sputum or bronchoalveolar lavage (BAL) is the cornerstone of the diagnosis, while trimethoprim-sulfamethoxazole is the treatment of choice. The etiological association of biologic agents with the occurrence of PJP is not entirely clear. Adalimumab is a fully human monoclonal anti-TNF-alpha antibody, which has been introduced relatively recently in the treatment of autoimmune inflammatory diseases, such as rheumatoid arthritis. In contrast to other biologic agents, such as Alemtuzumab or Infliximab, there are a small number of reports that support the drug's ability to trigger the occurrence of PJP. Hereby, we present a 53-year-old female patient with a medical history of rheumatoid arthritis on Adalimumab therapy, who developed PJP and we will discuss the main characteristics of PJP and the possible contribution of biologics to the occurrence of the infection.

Malignant External Otitis: What the Diabetes Specialist Should Know-A Narrative Review.

AIMS: Malignant external otitis (MEO) is a special type of external otitis associated with extensive inflammation and osteomyelitis. It is believed to originate from the external auditory meatus and advance regionally to the soft tissues and the bone, eventually involving the skull base. Pseudomonas aeruginosa and diabetes mellitus are factors commonly involved in the pathogenesis of MEO. Although its treatment has changed considerably during the last decades, morbidity and mortality of the disease remain high. Our aim was to review basic aspects of MEO, a disease unknown until 1968, which attracts great interest among Ears, Nose and Throat (ENT), diabetes and infectious diseases specialists. METHODS AND RESULTS: In this narrative review we mainly include relevant papers written in English or with an English abstract. We searched PubMed and Google Scholar, using the keywords malignant external otitis, malignant otitis externa, necrotizing external otitis, skull base osteomyelitis, diabetes mellitus and surgery up to July 2022. Some of the most recent articles, with specific references to earlier articles and a book reference regarding the pathophysiology, diagnosis and treatment of MEO and its relationship to diabetes mellitus, were included. CONCLUSION: MEO is not an uncommon disease and is principally treated by ENT surgeons. Nevertheless, diabetes specialists should be aware of the disease presentation and management, since they will often encounter patients with undiagnosed MEO or will need to manage glucose levels in patients hospitalized with the disease.

The Role of Individualized Exercise Prescription in Type 2 Diabetes Mellitus Management.

The adoption and the maintenance of a proper training routine are critical elements for optimal blood glucose management and overall health improvement in individuals with diabetes. Physical activity reduces cardiovascular risk, contributes to weight loss and improves overall wellbeing. A combination of aerobic and resistance exercise maximizes the benefit of daily training. The risk of exercise-induced complications varies depending on the activity type and the presence of diabetes-related complications. Prescribing a personalized exercise programme may reduce the risk and maximize the benefit of physical activity in patients with diabetes.

Imeglimin: A New Promising and Effective Weapon in the Treatment of Type 2 Diabetes.

Imeglimin is a novel molecule currently under development for the treatment of type 2 diabetes mellitus, and is the first agent of the 'glimin' class of glucose-lowering medication. It has a unique mechanism of action that targets the three main pathophysiologic components of type 2 diabetes: impaired glucose uptake by muscle tissue, excess hepatic gluconeogenesis and increased ß-cell apoptosis. To date, imeglimin has been evaluated in many preclinical and clinical trials and has shown to have notable antihyperglycaemic effects, such as statistically significant reductions in glycated haemoglobin, fasting plasma glucose and other glycaemic parameters. The encouraging tolerability profile, combined with its efficacy, could make it suitable as a monotherapy or in combination with other classes of antidiabetic agents, hopefully in the near future.

Changing the Concept: From the Traditional Glucose-centric to the New Cardiorenal-metabolic Approach for the Treatment of Type 2 Diabetes.

Type 2 diabetes mellitus (T2DM) is a chronic disease with a constantly increasing prevalence worldwide. It is well established that T2DM affects both the macro- and microvasculature, and its presence is associated with a high risk of acute and chronic cardiovascular events. Traditionally, the management of T2DM has been mainly focused on the optimization of blood glucose levels with the use of antidiabetic medications. During recent years, however, an impressive accumulation of evidence has arisen from studies designed to explore the plausible effects of new antidiabetic drugs on cardiovascular outcomes in patients with diabetes. This review article aims to emphasize the findings of these studies and to highlight the substantial role of the newer classes of antidiabetic drugs in treating T2DM in a holistic, cardiorenal-metabolic approach, thus shifting the paradigm from the traditional, simplistic, glucose-lowering approach.

Managing Diabetes During the COVID-19 Pandemic.

The coronavirus disease 2019 (COVID-19) pandemic has affected almost every country in the world and has changed the way we access healthcare. People with pre-existing conditions, such as diabetes, are at high risk of a severe disease course and it is essential that, as well as good hygiene and social distancing measures, blood glucose is carefully monitored, as chronic hyperglycaemia can lead to immune dysfunction. People with diabetes should be encouraged to continue medication prescribed for hypertension, diabetes or dyslipidaemia. Furthermore, patients with diabetes and COVID-19 infection should follow their usual antidiabetic treatment with the exception of sodium-glucose cotransporter-2 inhibitors. As the current pandemic situation has rendered some patients unable to access routine healthcare, telehealth may help those with travel restrictions.