Chronic CHD in diabetic patients is characterized by an increased VEGF myocardial expression and a decreased expression of its receptors along with a down-regulation of its signal transduction. The latter could be partially responsible for the reduced neoangiogenesis in diabetic patients with ischemic cardiomyopathy.

Lung ultrasound (LUS) in the emergency department (ED) has shown a significant role in the diagnostic workup of pulmonary edema, pneumothorax and pleural effusions. The aim of this study is to assess the reliability of LUS for the diagnosis of acute pneumonia compared to chest X-ray (CXR) study. The study was conducted from September 2013 to March 2015. 107 patients were admitted to the ED with a clinical appearance of pneumonia. All the patients underwent a CXR study, read by a radiologist, and an LUS, performed by a trained ED physician on duty. Among the 105 patients, 68 were given a final diagnosis of pneumonia. We found a sensitivity of 0.985 and a specificity of 0.649 for LUS, and a sensitivity of 0.735 and specificity of 0.595 for CXR. The positive predictive value for LUS was 0.838 against 0.7 for CXR. The negative predictive value of LUS was 0.960 versus 0.550 for CXR. This study has shown sensitivity, positive predictive value and negative predictive value of LUS compared to the CXR study for the diagnosis of acute pneumonia. These results suggest the use of bedside thoracic US first-line diagnostic tool in patients with suspected pneumonia.

OBJECTIVE -The purpose of this study was to assess the prevalence of cardiorenal risk factors, their management in a routine clinical setting, and the actual achievement of international guideline targets in a large cohort of type 2 diabetic patients with diabetic nephropathy.RESEARCH DESIGN AND METHODS -A multicentric cross-sectional study was performed in the Campania region in Italy to evaluate cardiorenal risk factors and their management in light of international guidelines. Overall, 28,550 diabetic patients were screened in the 21 participating centers; 847 (348 male and 449 female) patients with type 2 diabetes and a clinical diagnosis of diabetic nephropathy were recruited.RESULTS -Of these subjects, 749 had microalbuminuria and 98 had macroalbuminuria. Targets for blood pressure, HbA 1c , LDL cholesterol, HDL cholesterol, and triglycerides were reached in, respectively, 17.5, 32.3, 30.7, 47, and 55.2% of the patients. Chronic renal failure (glomerular filtration rate Ͻ60 ml/min) was revealed in 41% and anemia in 23.8% of the patients.CONCLUSIONS -This is the first study to investigate a large cohort of type 2 diabetic patients with early and moderate diabetic nephropathy strictu sensu. Notably, impaired renal function can be often diagnosed in these patients even in the presence of microalbuminuria. Thus, clinical diagnosis of diabetic nephopathy allows us to identify a group of patients at very high cardiorenal risk, for whom care is really difficult. We suggest that a correct diagnosis of diabetic nephropathy should always be made and that sodium intake and anemia should be routinely evaluated in these patients. Diabetes Care 29:498 -503, 2006D iabetic nephropathy in patients with type 2 diabetes has a cumulative prevalence of 30 -40% (1) and is currently the leading cause of end-stage renal disease (ESRD) in Western countries. Diabetic patients with renal damage are at higher risk of fatal and nonfatal cardiovascular events (1), and, as a consequence, diabetic nephropathy has also become an economic issue (2).Epidemiological studies have demonstrated that the factors strictly correlated to the progression of nephropathy in diabetic patients are arterial blood pressure, glycemic control, lipid levels, proteinuria levels, obesity, anemia, and cigarette smoking, with most of these critically influencing mortality (3,4). Nevertheless, what is emerging is the fact that physicians must treat the global cardiovascular risk rather than a single risk factor to achieve maximal renal and cardiovascular protection. Consequently, the number and strictness of the targets have increased, together with the difficulty of reaching them.Data from interventional studies in type 2 diabetic populations with overt (5,6) or also early nephropathy (7), who are expected to have a very high prevalence of cardiovascular risk factors (8), indirectly suggest that new targets are hard to achieve even in the groups receiving intensive therapy. However, no study has specifically evaluated the implementation of guidelines in patients...

A clinically based diagnosis of DN in Type 2 diabetes allows the identification of subjects with high CV risk. Albuminuria has a relevant prognostic effect on CV morbidity and mortality; its effect is especially pronounced when GFR is normal or near normal.

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