Association between microfibrillar-associated protein 4 (MFAP4) and micro- and macrovascular complications in long-term type 1 diabetes mellitus

AIMS

To evaluate microfibrillar-associated protein 4 (MFAP4) as a marker of micro- and macrovascular complications in patients with type 1 diabetes.

METHODS

This cross-sectional study included 203 persons with a long duration of type 1 diabetes from a population-based cohort ascertained in the former Funen County, Denmark. Detection of plasma-MFAP4 (pMFAP4) was performed by the AlphaLISA Technique. Diabetic retinopathy (DR) was graded in accordance with the Early Treatment Diabetic Retinopathy Study adaptation of the modified Airlie House classification. A monofilament test was used to test for neuropathy, and nephropathy was evaluated in a single spot urine sample. Data describing macrovascular disease were obtained from the Danish National Patient Register.

RESULTS

Median age and duration of diabetes were 58.7 and 43 years, respectively, and 61% were males. High levels of pMFAP4 were found in participants of old age, in women and in non-smokers (p < 0.05). In a multiple logistic regression model, patients with high levels of pMFAP4 were more likely to have diabetic neuropathy (OR 2.47 for quartile 4 versus quartile 1, 95% CI 1.01-6.03). No association was found between pMFAP4 and proliferative diabetic retinopathy, nephropathy or macrovascular disease.

CONCLUSIONS

No association between pMFAP4 and macrovascular vascular complications was found. However, high levels of pMFAP4 correlated independently with diabetic neuropathy. Further studies on the predictive value of increased circulating MFAP4 in diabetic neuropathy are warranted.

The relationships between rugby ground pass accuracy and kinematic variables resulting from two different pelvic orientations

Introduction: Despite having been largely understudied, one of the crucial components of a team’s success in rugby is accurate passing. This study identified biomechanical correlates of the rugby ground pass and accuracy performance.Methods: Sixteen club players (height 1.77±0.04 m; mass 86.8±16.8 kg) undertook a combined total of 96 passes and their respective body kinematics were analysed concurrent with measurements of pass accuracy at 10 m. Two distinct types of body orientations were found to be utilised by the players: a side-on orientation (pelvic rotation >80 °) and a front-on orientation (pelvic rotation <80 °).Results: Side-on body orientation passes were more accurate than front-on body orientation passes (p<0.0001). Fair relationships were present between the pass accuracy and upper body and hip kinematics for the two distinct body orientations individually. However, no common relationships were observed between the different orientations.Conclusion: Therefore different strategies exist within players to perform the ground pass with varying grades of accuracy.

Guidelines for the investigation and management of a reduced level of consciousness in children: implications for clinical biochemistry laboratories

Whenever a child presents to hospital with a reduced level of consciousness, admitting clinicians have to decide the underlying cause rapidly so that the correct emergency treatment can be initiated. Unfortunately, the clinical presentations of many of the possible diagnoses are very similar. The diagnosis often results from investigations within the clinical biochemistry laboratory. In the past, clinicians have had limited guidance on which tests to request when presented with a child with a reduced level of consciousness. Guidelines have recently been developed relating to all aspects of management of the child in a coma. Due to a lack of evidence in the literature regarding the most appropriate first line tests for children with a reduced level of consciousness, a formal consensus process ('Delphi consensus') was performed using a large multidisciplinary panel of experts. The recommendations reached by this process include the list of initial ('core') tests to request for all children with a reduced level of consciousness (excluding those immediately after suffering a convulsion and those involved in obvious trauma). Depending upon the results of these 'core' tests and the clinical condition of the child, further tests may be requested later. The key point is that all the samples have been taken at the time of presentation to provide the best chance of reaching a diagnosis and correctly treating the child. The article reviews the recommended core investigations and further tests and discusses how individual laboratories can help to implement the guidelines jointly with their Emergency and Paediatric Departments.

Assessment of a rapid liquid-based cytology method for measuring sputum cell counts

Differential sputum cell counting is not widely available despite proven clinical utility in the management of asthma. We compared eosinophil counts obtained using liquid-based cytology (LBC), a routine histopathological processing method, and the current standard method. Eosinophil counts obtained using LBC were a strong predictor of sputum eosinophilia (≥3%) determined by the standard method suggesting LBC could be used in the management of asthma.

Societal costs of diabetes mellitus in Denmark

AIM

To provide comprehensive real-world evidence on societal diabetes-attributable costs in Denmark.

METHODS

National register data are linked on an individual level through unique central personal registration numbers in Denmark. All patients in the Danish National Diabetes Register in 2011 (N = 318 729) were included in this study. Complication status was defined according to data from the Danish National Hospital Register. Diabetes-attributable costs were calculated as the difference between costs of patients with diabetes and the expected costs given the annual resource consumption of the diabetes-free population.

RESULTS

Societal costs attributable to diabetes were estimated to be at least 4.27 billion EUR in 2011, corresponding to 14,349 EUR per patient-year. A twofold higher healthcare resource usage was found for patients with diabetes as compared with the diabetes-free population. Attributable costs, grouped according to different components, were 732 million EUR for primary and secondary care services, 153 million EUR for pharmaceutical drugs, 851 million EUR for nursing services, 1.77 billion EUR in lost productivity and 761 million EUR for additional costs. A steep increase in diabetes-attributable costs was found for patients with major complications compared with patients without complications across all cost components. For attributable healthcare costs this increase was estimated to be 6,992 EUR per person-year after controlling for potential confounders.

CONCLUSIONS

Nearly half of the total costs of patients with diabetes can be attributed directly to their diabetes. The majority of costs are incurred among patients with major complications pointing to the importance of secondary preventive efforts among patients with diabetes.

Maids, Migrants and Occupational Health in the London Sex Industry

It has been argued that norms of occupational health have weakened with diversification in the sex industry. We explore this issue in walk-in flats in London, focusing on relationships between managers (maids) and sex workers. Today, most maids are local and most sex workers are 'migrants'. We collected data on 117 maids and sex workers, and carried out intensive fieldwork with seven maids and 17 sex workers. Managers take prime responsibility for educating and inducting new workers. Authoritarian management has been considered bad for health both in these walk-in flats and in the '100 per cent condom use programme' criticized by sex workers' projects. Yet, we found that maids acted as friends and managers, which helped settle new sex workers. Over time, however, migrants were more affected by issues of isolation and exploitation than local workers. Alternative models of health promotion such as peer education must be seen in a wider legal context where the lack of rights makes it difficult to appeal against exploitation, or to become mobile.

Doege-Potter Syndrome

Doege-Potter syndrome is a rare paraneoplastic syndrome presenting as a hypoinsulinaemic hypoglycaemia from the ectopic secretion of a prohormone of insulin-like growth factor II (IGF-II) from a solitary fibrous tumour. Surgical resection is curative in the majority of cases. If, however, the diagnosis is not suspected and treatment is delayed, it can lead to hypoxic cerebral injury or death. The underlying tumour can be a benign or malignant pleural tumour but may be present in extrapleural sites. For a diagnosis of Doege-Potter syndrome, symptoms attributable to hypoglycaemia and low blood glucose levels should be present along with the secretion of prohormone IGF-II. We report a case of severe hypoglycaemia in a 76-year-old inpatient admitted for resection of a recurrent left-sided pleural tumour. Investigation revealed true hypoglycaemia and Doege-Potter syndrome was diagnosed. The tumour was completely resected and the patient made a full recovery with no further hypoglycaemic episodes.