Hypoglycemia Alert Dogs: A Novel, Cost-effective Approach for Diabetes Monitoring?

The recent publication of the results of 3 small trials, and as many as 5 case reports on dogs producing clear and intelligible alerts in the presence of their owners' hypoglycemia, opens an intriguing clinical scenario for management of diabetes. The skill seems attributable to the ability of dogs to identify patterns in skin and breath odors as well as to understand and interpret visual cues from humans during hypoglycemia. Provided that further trials can confirm the findings, the use of diabetes alert dogs that are trained to detect the onset of hypoglycemia can be regarded as a fast, versatile, reliable, and cost-effective approach for safeguarding the health of individuals with diabetes.

Fish Intake and Venous Thromboembolism: A Systematic Literature Review.

Diet plays an important role in modulating the risk of arterial and venous thrombosis. Several lines of evidence attest that consumption of fish and its compounds, especially omega-3 fatty acids, may be effective to decrease the cardiovascular risk. Since the pathogenesis of arterial and venous thrombosis share some common aspects, we performed a systematic review of published clinical studies that investigated the association between fish intake and venous thrombosis. An electronic search was carried out in Medline, Scopus, and ISI Web of Science using the key words "fish" OR "seafood" AND "venous thromboembolism" OR "deep vein thrombosis" OR "pulmonary embolism", with no language or date restriction. Overall, 6 studies (5 prospective and 1 case-control) were finally identified. In only 1 small case-control study, a larger intake of total fish was found to be negatively associated with the risk of venous thromboembolism. No association was found in 4 large prospective studies, whereas a positive association was observed in the remaining. No substantial difference was also noticed between intake of fatty or lean fish. Taken together, the current epidemiological evidence does not support the existence of a significant effect of total fish consumption on the risk of venous thromboembolism.

The burden of vitamin D deficiency in a mediterranean country without a policy of food fortification.

BACKGROUND: Vitamin D deficiency is a public healthcare issue and its correction is increasingly regarded as a cornerstone of preventive medicine. METHODS: We designed a retrospective observational study to clearly define the burden of total vitamin D (25-hydroxyvitamin D) deficiency in a supposedly healthy population of outpatients residing in two regions (Emilia Romagna and Veneto) of Northern Italy. RESULTS: 25-hydroxyvitamin D results were available for a total number of 5,096 outpatients in the two centers. The median value of 25-hydroxyvitamin D was 60 nmol/L, and was higher in women than in men (62 nmol/L versus 56 nmol/L; p<0.001). The rate of 25-hydroxyvitamin D deficiency was 36%, and was marginally but significantly higher in men than in women (40% versus 35%; p=0.003). A significant variation in the rate of 25-hydroxyvitamin D deficiency was found throughout different age ranges, exhibiting a significant increase in the elderly. CONCLUSIONS: The results of this large observational study show that the burden of 25-hydroxyvitamin D deficiency in two regions of a Mediterranean country without a policy of food fortification is as high as 36%, and this evidence represents a background for healthcare preventive measures aimed at reducing the prevalence of this condition in the general population. (www.actabiomedica.it).

Serum potassium levels inversely correlate with D-dimer in patients with acute-onset atrial fibrillation.

BACKGROUND: D-dimer values are frequently increased in patients with atrial fibrillation (AF) compared to subjects in sinus rhythm. Hypokalemia plays a role in several cardiovascular diseases, but little is known about the association with AF. OBJECTIVE: D-dimer values are frequently increased in patients with atrial fibrillation (AF) compared with subjects in sinus rhythm. Hypokalemia plays a role in several cardiovascular diseases, but little is known about the association with AF. The aim of this study was to investigate correlations between D-dimer and serum potassium in acute-onset AF (AAF). METHODS: To investigate the potential correlation between the values of serum potassium and D-dimer in patients with AAF, we retrospectively reviewed clinical and laboratory data of all emergency department visits for AAF in 2013. RESULTS: Among 271 consecutive AAF patients with D-dimer assessments, those with hypokalemia (n = 98) had significantly higher D-dimer values than normokalemic patients (139 versus 114 ng/mL, p = 0.004). The rate of patients with D-dimer values exceeding the diagnostic cut-off was higher in the group of patients with hypokalemia than in those with normal serum potassium (26.5% versus 16.2%; p = 0.029). An inverse and highly significant correlation was found between serum potassium and D-dimer (r = -0.21; p < 0.001), even after adjustments for age and sex (beta coefficient -94.8; p = 0.001). The relative risk for a positive D-dimer value attributed to hypokalemia was 1.64 (95% CI, 1.02 to 2.63; p = 0.040). The correlation remained statistically significant in patients free from antihypertensive drugs (r = -0.25; p = 0.018), but not in those taking angiotensin-receptor blockers, angiotensin-converting enzyme inhibitors, or diuretics. CONCLUSIONS: The inverse correlation between values of potassium and D-dimer in patients with AAF provides important and complementary information about the thromboembolic risk of these patients.

Serum Potassium Levels Inversely Correlate with D-Dimer In Patients with Acute-Onset Atrial Fibrillation / Concentrações Séricas de Potássio Encontram-se Inversamente Correlacionadas aos Níveis de D-Dímero em Pacientes com Fibrilação Atrial Aguda

Background: D-dimer values are frequently increased in patients with atrial fibrillation (AF) compared to subjects in sinus rhythm. Hypokalemia plays a role in several cardiovascular diseases, but little is known about the association with AF. Objective: D-dimer values are frequently increased in patients with atrial fibrillation (AF) compared with subjects in sinus rhythm. Hypokalemia plays a role in several cardiovascular diseases, but little is known about the association with AF. The aim of this study was to investigate correlations between D-dimer and serum potassium in acute-onset AF (AAF). Methods: To investigate the potential correlation between the values of serum potassium and D-dimer in patients with AAF, we retrospectively reviewed clinical and laboratory data of all emergency department visits for AAF in 2013. Results: Among 271 consecutive AAF patients with D-dimer assessments, those with hypokalemia (n = 98) had significantly higher D-dimer values than normokalemic patients (139 versus 114 ng/mL, p = 0.004). The rate of patients with D-dimer values exceeding the diagnostic cut-off was higher in the group of patients with hypokalemia than in those with normal serum potassium (26.5% versus 16.2%; p = 0.029). An inverse and highly significant correlation was found between serum potassium and D-dimer (r = −0.21; p < 0.001), even after adjustments for age and sex (beta coefficient −94.8; p = 0.001). The relative risk for a positive D-dimer value attributed to hypokalemia was 1.64 (95% CI, 1.02 to 2.63; p = 0.040). The correlation remained statistically significant in patients free from antihypertensive drugs (r = −0.25; p = 0.018), but not in those taking angiotensin-receptor blockers, angiotensin-converting enzyme inhibitors, or diuretics. Conclusions: The inverse correlation between values of potassium and D-dimer in patients with AAF provides important and complementary information about the thromboembolic ...

Fundamento: Valores de D-dímero são frequentemente aumentada em pacientes com fibrilação atrial (FA) em comparação com indivíduos em ritmo sinusal. A hipocalemia desempenha um papel em várias doenças cardiovasculares, mas pouco se sabe sobre a associação com FA. Objetivo: As concentrações de D-dímero encontram-se frequentemente aumentadas em pacientes com FA, quando comparados com indivíduos em ritmo sinusal. A hipopotassemia desempenha um papel importante nas doenças cardiovasculares, porém, pouco é conhecido sobre sua associação com a FA. O objetivo deste estudo foi investigar a correlação entre os níveis séricos de D-dímero e potássio na FA aguda (FAA). Métodos: Para investigar a existência de uma potencial correlação entre os níveis séricos de potássio e D-dímero em pacientes com FAA, realizamos uma revisão retrospectiva de dados clínicos e laboratoriais relacionados a todas as visitas ao departamento de emergência devido à FAA, no ano de 2013. Resultados: Entre os 271 pacientes com FAA, aqueles com hipopotassemia (n = 98) mostraram aumento significativo nos níveis de D-dímero, quando comparados com pacientes com concentrações normais de potássio (139 versus 114 ng/mL, p = 0,004). A taxa de pacientes com níveis de D-dímero excedendo o valor limiar de diagnóstico foi maior no grupo de pacientes com hipopotassemia, quando comparado com o grupo de pacientes com concentrações normais de potássio (26,5% versus 16,2%; p = 0,029). Detectamos uma correlação inversa e altamente significativa entre os níveis séricos de potássio e D-dímero (r = -0,21; p < 0,001), até mesmo após ajuste para idade e sexo (coeficiente beta –94,8; p = 0,001). O risco relativo de um valor positivo de D-dímero estar relacionado à hipopotassemia foi de 1,64 (95% CI, 1,02 to 2,63; p = 0,040). A correlação permaneceu estatisticamente significativa em pacientes livres de medicamentos hipertensivos (r = -0,25; p = 0,018), porém não nos pacientes em tratamento ...

Initial blood lactate correlates with carboxyhemoglobin and clinical severity in carbon monoxide poisoned patients.

OBJECTIVE: The aim of this study was to assess the role of blood lactate levels at admission in carbon monoxide (CO)-poisoned patients for establishing severity of poisoning and short term prognosis. METHOD: All cases of CO poisoning visited in the emergency department during the years 2012 and 2013 were retrieved from the hospital database. The concentration of COHb and lactate was assessed in arterial blood in all patients with suspected CO poisoning, along with the plasma concentration of troponin I (TnI). The control population for TnI results consisted in 125 blood donors. RESULTS: Twenty three (61%) out of 38 CO-poisoned patients underwent hyperbaric oxygen (HBO) treatment, and 10 (26%) were admitted to a hospital ward. A significant correlation was found between lactate and COHb (r=0.54; p<0.001), and between lactate and TnI (r=0.44; p=0.001). A significant correlation was also found between COHb and TnI (r=0.38; p=0.020). Blood lactate levels were higher in patients treated with HBO and hospital admission. In multivariate analysis, none of the parameters was associated with HBO treatment, whereas increased value of blood lactate (p=0.036) was the only significant predictor of hospital admission. Twenty five (66%) patients had detectable TnI levels compared to 13% controls (p<0.001), whereas 16% CO-poisoned patients had TnI levels >99th percentile compared to 2% controls (p=0.003). The odds ratio for detectable TnI and TnI >99th percentile in CO-poisoned patients were 13.1 (p<0.001) and 7.6 (p=0.006), respectively. CONCLUSION: Initial blood lactate level may be useful for risk stratification of CO-poisoned patients, especially for predicting hospitalization.

[Sometimes they come back! A case of Shoshin Beriberi in Northern Italy (2012)]. / A volte ritornano! Un caso di Shoshin Beriberi nel Nord Italia (2012).

A 78-year-old man presented to the emergency department with symptoms and signs suggestive of heart failure. Only after a long interview we discovered that the patient has been eating, for over 20 years, only chestnut honey and chestnut jam produced by himself. He refused any other foods, because of the fear of being poisoned; he did not drink alcohol at all. The clinical picture was attributable to Beriberi, and the patient recovered promptly after treatment with thiamine. A high clinical suspicion and an early thiamine supplementation might shorten the duration of work-up and hospital length of stay, as well as prevent extensive and expensive diagnostic work-up, thus simplifying the clinical management.

No evidence for an association of vitamin D deficiency and migraine: a systematic review of the literature.

Vitamin D deficiency is associated with a number of human disorders, including cardiovascular disease, cancer, diabetes, frailty, and infections. Since an association between vitamin D and migraine has also been recently speculated, we performed an electronic search on Medline, Scopus, and Web of Science using the keywords "migraine" and "vitamin D," "25OH-D" "cholecalciferol," "ergocalciferol," with no language or date restriction. The electronic search allowed identifying seven studies (3 observational, 2 cross-sectional, and 2 case reports). The two case reports, including four women, showed favourable effects of vitamin D supplementation on migraine severity, but these studies were small and not placebo controlled. As regards the three observational studies, vitamin D deficiency was observed in 13.2 to 14.8% of migraine patients, and these rates do not differ from those reported in the general population (i.e., vitamin D deficiency between 22 and 42%). The results of the two cross-sectional studies are even more controversial, since no association was found between vitamin D status and migraine in both trials. In conclusion, the current evidence suggests that the association between migraine and vitamin D lacks reliable scientific support.

Homocysteine and migraine. A narrative review.

Recent evidence suggests that migraine is associated with an increased risk of cardiovascular disorders, so that it is increasingly hypothesized that this primary form of headache may be linked to thrombotic diseases by some biological pathways and risk factors. Homocysteine, a sulfur-containing molecule, is now recognized as an independent risk factor for a variety of thrombotic disorders, especially ischemic heart disease and stroke. This article is hence aimed to provide an overview of epidemiological evidence about the association between homocysteine and migraine published in cross-sectional, prospective or interventional studies. Overall, the evidence gathered from cross-sectional studies that measured plasma homocysteine levels suggests that the epidemiological link between the plasma concentration of this biomarker and migraine is very weak, at best. Contradictory evidence emerged from interventional studies, in which treatment of hyperhomocysteinemia with folic acid or vitamin B supplementation was effective to lower plasma homocysteine and decrease frequency and/or severity of migraine. The association remains largely speculative, however, since it could not be clearly demonstrated that these two biological effects were directly linked. The only study that has assessed homocysteine in cerebrospinal fluid reported that the concentration of this biomarker in migraine patients was significantly increased compared to controls. Although this evidence must be obviously confirmed in larger trials, some putative mechanisms may support a causal link between increased generation of homocysteine in the brain environment and migraine.

[Swept away and squashed between myth based medicine and eminence based medicine. Metaphor of medical meta-cognition. What are we doing wrong with our patient?]. / Travolti da un insolito destino e compressi tra Myth Based Medicine e Eminence Based Medicine. Metafora della meta-cognizione medica, ovvero: cosa stiamo sbagliando con il nostro paziente?

Myths have played essential social functions throughout human history, and modern medical culture makes no exception. Despite ongoing scientific efforts, clinicians still encounter biological phenomena that they can hardly explain. In this ocean of uncertainty they continue, either consciously or unconsciously, to convey a number of myths, which are also used as professional tools. Although in recent decades clinical research and randomized trials have emerged as the main arbiters of truth in medicine, there are still large areas of uncertainty that are consistently filled up with tradition, common sense and experience. In this context, mysticism seldom represent a latent source of error, especially when it penetrates education and medical literature, so growing to the role of indisputable truth, which can hardly be eradicated. The aim of this article is to discuss some paradigmatic examples of medical myths, such as the use of beta-blockers in patients with heart failure, the risk of administering opioids in patients with abdominal pain, the suggestion to drink at least eight glasses of water per day, the risk of using contrast media in patients with shellfish allergy, the indiscriminate prescription of a huge number of laboratory tests to achieve an efficient diagnosis, the use of garlic for treat a kaleidoscope of human disorders, fructose as a viable replacement for sucrose, the relationship between obesity and mortality or between sex and caloric consumption, and the cognitive biases.

Pathophysiology, clinics, diagnosis and treatment of heart involvement in carbon monoxide poisoning.

The toxicity of carbon monoxide has been recognized for long throughout history and is unquestionably the leading cause of unintentional poisoning deaths in the Western countries. The severity of poisoning is dependent upon environmental and human factor. The leading pathophysiological mechanism resides in the ability of carbon monoxide to bind to hemoglobin molecules with high affinity, displacing oxygen and generating carboxyhemoglobin, which is virtually ineffective to deliver oxygen to the tissues. The organs with the highest demand for oxygen such as the brain and the heart are more vulnerable to injury. Myocardial involvement is commonplace in moderate to severe carbon monoxide poisoning and is associated with a substantially higher risk of mortality. Besides hypoxic damage, carbon monoxide produces myocardium injuries with cardiospecific mechanisms, mostly attributable to direct damage at cellular or subcellular level. The clinical spectrum of heart involvement is broad and encompasses cardiomyopathy, angina attack, myocardial infarction, arrhythmias and heart failure up to myocardial stunning, cardiogenic shock and sudden death. Patients with underlying cardiac disease, especially coronary heart disease, are at greater risk of infarction and arrhythmias. Single photon emission computed tomography (SPECT) is the technique of choice for diagnosing cardiac involvement, whereas the recent introduction of the highly sensitive troponin immunoassays seems promising for the early triage of patients. No specific treatment other than oxygen delivery can be advocated for cardiac toxicity at present, and 100% oxygen therapy should be continued until the patient is asymptomatic and carboxyhemoglobin levels decrease below 5-10%.

[A journey with Euterpe. Sinfonia concertante for music, heart and brain]. / In viaggio con Euterpe. Sinfonia concertante per musica, cuore e cervello.

Unlike the Overlords, the highly cerebral alien beings of the Arthur Clarke's novel "Childhood's End", humans are strongly oriented toward music. Since the ancient cultures, the impact of music in eliciting physical and emotional reactions has been acknowledged, but its relationship with organic reactions has been mostly attributed to the domain of magic. Consistent experimental evidence shows that certain types of melody and rhythm might truly influence cardiovascular and neurophysiologic behaviours, while producing biochemical effects (e.g., reduction of stress), depending on the personal musical background of the listeners. As such, although the physiological basis is still poorly recognized, listening to the music has been proposed as a therapeutic for the treatment of a variety of disorders (the "Mozart effect"). This article, written in a "musical-like" form, provides a comprehensive analysis of reliable evidence supporting the influence of music on biochemistry and physiology, and concluding that the influence of music on human behaviours should be no longer confined to the realms of anecdote.

From music-beat to heart-beat: a journey in the complex interactions between music, brain and heart.

Although the potential influence of music in eliciting organic reactions has been appreciated since the ancient Assyrian and Greek cultures, its relationship with body responses has been believed for long to belong to the field of magic. Growing experimental evidence now attests that some kind of music might indeed modulate several cardiac and neurological functions, as well as trigger biochemical measurable stress-reducing effects in certain individuals, mostly depending on their subjective musical education. On this basis, music has been increasingly used as a therapeutic tool in the treatment of different diseases in healthy and ill subjects over recent years (e.g., the so called "Mozart effect"), although the underlying scientific background is still poorly understood. The aim of this article is to review the current scientific evidences about the complex and multifaceted interactions between music and human biology.