Non-Diabetic Kidney Disease in Patients with Type 2 Diabetes Mellitus-11-Year Experience from a Single Center

Introduction

In patients with diabetes mellitus (DM), non-diabetic renal disease (NDRD) can also occurs, as well as diabetic nephropathy. NDRD is most accurately diagnosed using kidney biopsy.

Aim

The aim of the study was to investigate the incidence and type of NDRD diagnosed by kidney biopsy in patients with type 2 DM and the correlation of clinical and laboratory findings with histopathological diagnosis.

Material and Methods

From April 2007 to October 2018, 290 kidney biopsies were performed at the Department of Nephrology, Internal Medicine Clinic in Banja Luka, out of which 18 patients (males 9, mean age 59.8 years) were with type 2 DM. The US-guided (ultrasound device: Toshiba Famio 5) kidney biopsy was performed using an automatic biopsy instrument FAST-GUN® with needle 16G. Kidney tissue samples were analyzed by light microscopy and immunofluorescence.

Results

In 18 patients with type 2 DM, the average duration of the disease was 5.9 years, 5 patients had a retinopathy, and 16 patients had hypertension. Biopsy indications were: nephrotic syndrome in 11 patients, asymptomatic urinary abnormalities in 3 patients, and rapid chronic renal failure progression. Unsatisfactory quality sample for pathohistological analysis was obtained in one patient, and out of the other 17, 6 (35.3%) had NDRD, 3 (17.6%) had NDRD superimposed with the diabetic nephropathy, and 8 (47.1%) had diabetic nephropathy. Of the patients who had NDRD, 3 had membranous glomerulonephritis, 1 had focal segmental glomerulosclerosis, and two had hypertensive nephroangiosclerosis. Out of patients with coexisting NDRD and diabetic nephropathy, 2 had hypertensive nephroangiosclerosis and one diabetic nephropathy and lupus nephritis.

Conclusion

NDRD was diagnosed using kidney biopsy in 9/17 patients with type 2 DM, which confirms the significance of the kidney biopsy in patients with DM with properly indications. Accurate diagnosis provides disease specific treatment and thus significantly improves the long-term prognosis of the patient.

Synchrotron radiation from an accelerating light pulse

Synchrotron radiation-namely, electromagnetic radiation produced by charges moving in a curved path-is regularly generated at large-scale facilities where giga-electron volt electrons move along kilometer-long circular paths. We use a metasurface to bend light and demonstrate synchrotron radiation produced by a subpicosecond pulse, which moves along a circular arc of radius 100 micrometers inside a nonlinear crystal. The emitted radiation, in the terahertz frequency range, results from the nonlinear polarization induced by the pulse. The generation of synchrotron radiation from a pulse revolving about a circular trajectory holds promise for the development of on-chip terahertz sources.

Synchrotron radiation from an accelerating light pulse

Synchrotron radiation—namely, electromagnetic radiation produced by charges moving in a curved path—is regularly generated at large-scale facilities where giga–electron volt electrons move along kilometer-long circular paths. We use a metasurface to bend light and demonstrate synchrotron radiation produced by a subpicosecond pulse, which moves along a circular arc of radius 100 micrometers inside a nonlinear crystal. The emitted radiation, in the terahertz frequency range, results from the nonlinear polarization induced by the pulse. The generation of synchrotron radiation from a pulse revolving about a circular trajectory holds promise for the development of on-chip terahertz sources.

Switching From Pre-mixed Insulin to Regimens with Insulin Glargine in Type 2 Diabetes: A Prospective, Observational Study of Data From Adriatic Countries

INTRODUCTION

Long-acting insulin analogs such as insulin glargine may offer improved glycemic control in patients with type 2 diabetes (T2D) compared to conventional insulin therapies. The objective of this study was to determine whether switching to insulin glargine had beneficial effects on glycemic control, weight gain, and incidence of hypoglycemia in patients with suboptimally managed T2D.

METHODS

This prospective observational study was performed on 1041 patients who were suboptimally controlled on pre-mixed insulin therapy and were switched to an insulin glargine regimen. Clinical markers of glycemic control including glycosylated hemoglobin (HbA1c) < 7% (< 53 mmol/mol) and fasting blood glucose (FBG) levels ranging from 3.9 to 7.2 mmol/L were used for the primary outcome measures. Follow-up assessment of primary outcomes, weight gain, incidence of hypoglycemia, and patient satisfaction with the therapy was performed after three and six months of treatment.

RESULTS

Target therapeutic values of HbA1c were achieved in 9.3% and 30.2% of patients, whereas FBG target values were achieved in 25.9% and 52.3% of patients after the third and sixth month of therapy, respectively. Both the HbA1c and FBG targets were reached in 7% and 25.9% of patients at the third and sixth month of therapy, respectively. Switching to insulin glargine decreased the incidence of hypoglycemia from 49.5% to 5.2% after six months of therapy; this decrease was associated with weight loss and was well perceived by the patients.

CONCLUSION

Insulin glargine-based regimens are beneficial and safe therapeutic alternatives for T2D patients inadequately controlled with pre-mixed insulin.

FUNDING

Sanofi-Aventis Croatia d.o.o., Zagreb, Croatia.

Myocardial injury after electrical burns: short and long term study

Miscellaneous cardiac abnormalities can occur after electrical burns. The long term outcomes are still unknown. We studied 10 patients, 9 of whom suffered high-voltage electrocution, and one of whom was struck by lightning. Serial electrocardiograms (ECG) and serum MB creatine phosphokinase isoenzyme (MB-CPK) activities were obtained during their stay in hospital. ECG and thallium 201 cardiac scintigraphy at rest, as well as echocardiograms were obtained in all patients 4 to 48 months after discharge. In hospital, 9 patients showed one or more abnormal findings at physical examination (4 cases), ECG (8 cases), MB-CPK (1 case). At long term follow-up, 5 patients had one or more myocardial functions or conduction abnormalities, with or without symptoms. One patient had compensated heart failure. Nine patients were asymptomatic. Abnormal ECG findings persisted in 3 patients. Three cardiac scans showed evidence of regional myocardial hypoperfusion. Decreases in left ventricular indices measured by echocardiogram were found in 3 patients. We conclude that high-voltage electrocution is associated with a high incidence of cardiac abnormalities, which may persist. Long term evaluation, requiring cardiac T1 201 scintigraphy and echocardiogram, may be justified.