Showing papers in "Endocrinology and Metabolic Syndrome in 2016"
TL;DR: Iodine defenses programmes can avoid adverse neurodevelopmental consequences in mothers and their offspring by preventing iodine deficiency in fetuses and Neonates.
Abstract: Thyroid Hormones (THs) play an essential role in development and hormone deficiency during critical phases in fetal life may lead to severe and permanent brain damage. Maternal iodine deficiency is considered the most common cause of fetal TH deficiency, but the problem may also arise in the fetus/neonates. Due to defects in fetal thyroid gland development or hormone synthesis, clinical symptoms at birth are often mild as a result of compensatory maternal TH supply. A shortage of THs starting at the early stages of pregnancy results in neurological deficits that cannot be rescued by exogenous TH addition at later stages. Neonates are more sensitive than adults to the effects of iodine deficiency. Thus, these disturbances may lead to abnormalities in the neuronal network and may result in mental retardation and other neurological defects, including impaired motor skills and visual processing. Thus, iodine defenses programmes can avoid adverse neurodevelopmental consequences in mothers and their offspring.
50 citations
TL;DR: Honey consumption resulted in more hyperglycemia in these patients, but without diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar state (HHS), and the macro-vascular complications, particularly the coronary heart disease (CHD), did not develop in any of them.
Abstract: Objectives: The complications from type 2 diabetes mellitus (DM) still occur despite the ongoing efforts to prevent, or decrease it. This clinical trial aimed to evaluate the effects of honey, as an alternative, non-expensive natural substance in twenty adult patient volunteers suffering from type 2 DM and its associated metabolic derangements.
Methods: The patients volunteered to stop the medicines and use honey as a sole treatment of their illnesses. There was no specific dietary restriction except for food preservatives and additives, beverages and sweets.
Results: Honey consumption resulted in more hyperglycemia in these patients, but without diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar state (HHS). Longer-term honey consumption resulted also in weight reduction in all the patients, and control of the blood pressure in the patients, who had hypertension before the honey intervention. The median duration of the honey intervention, without anti-diabetic medicines was 1.09 years, with a range from 0.42 to 13.5 years. Ten of the 20 patients continued the honey intervention for more than 1 year, whereas the other 10 continued the intervention for one year or less. The only cause of the discontinuation of the honey intervention was persistent hyperglycemia. Despite persistent hyperglycemia in all the patients, and persistence of the dyslipidemia in the patients, who had dyslipidemia before the intervention, the macro-vascular complications, particularly the coronary heart disease (CHD), did not develop in any of them. On the contrary, the cardiovascular status improved in the patients, who had CHD before the intervention. However, micro-vascular complications developed in two patient volunteers, who continued the honey intervention, without medicines, for more than 8 years.
Conclusion: The author imposed on announcing these results, which might be of help for the patients with diabetes mellitus.
26 citations
TL;DR: Placenta was not the primary cause to markedly affect the perinatal morbidity as the placenta showed a good degree of potentiality to adapt with derangements of gestational diabetes, putting diabetes in the moderate-high risk factors of vascular placental pathology.
Abstract: Gestational diabetes is the glucose intolerance of varying severity and complicates about 2-4% of pregnancies. While there is a surfeit of associative data that demonstrate the placental adaptive responses to gestational diabetes, the mechanisms at placental level remain elusive. One objective of this study was to investigate various anatomical, histological and some histochemical changes in placenta of gestational diabetes patients with re-evaluation of some mechanisms of placental adaptive responses to gestational diabetes. A second objective was to find whether the placenta adapts to diabetes and ultimately protects the fetus or whether it contributes to the adverse fetal outcome with diabetic pregnancies despite good care of these gestations. Two groups each of 30 placentas were collected at term and post Caesarian Section (CS) deliveries as one group was the control group (control) and the other group was collected from patients with gestational diabetes and were treated with zinc insulin. After morphological data assay, central and peripheral biopsies were processed for histological and histochemical assay. The diabetic placentas showed mild increase in diameter, central thickness and weight. This study confirmed that the villous portion with its corresponding intervillous space is the structural and functional unit of the placenta. Syncytial clumps among peripheral placenta were bigger than those of central placenta of the diabetic group and best examined by Hematoxylin and Eosin stain and to a lower extent by Van Gieson stain for light microscopy. The diabetic placentas showed marked increase of the chorionic villi which appeared more crowded centrally while the villous vasculature was higher peripherally. The increased young, immature and unspecialized villi among the diabetic placentas explained the enhanced fetal hypoxia with subsequent increased neonatal morbidity and mortality. These anatomical, histological and histochemical findings put diabetes in the moderate-high risk factors of vascular placental pathology. Also, placenta was not the primary cause to markedly affect the perinatal morbidity as the placenta showed a good degree of potentiality to adapt with derangements of gestational diabetes. So, the elevated rates of perinatal morbidity and mortality among diabetic deliveries were most probably due to metabolic abnormalities occurred in mother and fetus because of whatever kind of diabetes. Conclusion: Placenta itself is always perfect, innocent and helpful in managing and preventing complications via its endogenous mechanisms. It was necessary histologically to examine several preparations with different and specific measures to obtain detailed picture of the totality of the placenta structure. Lastly, the premium key in gestational diabetes is to apply scientific exogenous measures in harmony and accordance with early diagnosed and strictly controlled endogenous placental measures.
23 citations
TL;DR: Unfolded protein response is an adaptive cellular response that adjust protein translation rate to specific external stress to mediate programmed cell death and insulin resistance in pathophysiological conditions such as diabetes.
Abstract: Unfolded protein response is an adaptive cellular response that adjust protein translation rate to specific external stress. This response has been demonstrated to mediate programmed cell death and insulin resistance in pathophysiological conditions such as diabetes. More recently, it has been demonstrated that the pharmacological activation of UPR in the hypothalamus is able to stimulate food intake through mechanism not completely determined.
13 citations
TL;DR: The role of galectin-3 in risk stratification in T2DM individuals is depicted and whether is rationale to achieve full control under serum galectIn-3 as a predictor of successful T2 DM treatment is not clear.
Abstract: Galectin-3 is a multifunctional chimaera-type β-galactoside binding protein that has been linked to incident Cardiovascular (CV) and renal disease, fibrosis and tissue injury. Elevated level of serum galectin-3 was found in patients with Type 2 Diabetes Mellitus (T2DM) and associate well with CV complications. The short commentary depicts the role of galectin-3 in risk stratification in T2DM individuals. Although perspectives of clinical implementation of galectin-3-guided therapy in T2DM patients are widely discussed, there is evidence regarding cyto-protective role of galectin-3 in diabetes. Whether is rationale to achieve full control under serum galectin-3 as a predictor of successful T2DM treatment is not clear. Further investigations are needed to explain the role of galectin-3 in T2DM development and progression
11 citations
TL;DR: It is hypothesize that stabilizing insulin sensitivity may have a positive effect on improving outcome in ESRD subjects, and it is suggested that stabilization insulin sensitivity should be focused on in order to improve outcome in patients with impaired kidney function.
Abstract: Insulin resistance accompanies many well-established cardiovascular risk factors, such as obesity, hypertension, dyslipidaemia and type 2 diabetes. Since cardiovascular disease (CVD) is the leading cause of death in patients with end stage renal disease (ESRD), insulin resistance is thought to play a role in the morbidity and mortality associated with ESRD. This paper reviews the available information on insulin resistance in patients with impaired kidney function as well as those on renal replacement therapy in the form of maintenance hemodialysis. Potential mechanisms for the dynamic changes in insulin resistance, which occur through the different stages of kidney disease, are also discussed. We hypothesize that stabilizing insulin sensitivity may have a positive effect on improving outcome in ESRD subjects.
9 citations
TL;DR: There is disagreement about the role of US elastography in thyroid nodules with indeterminate or non-diagnostic cytology, and the histologic examination is often necessary to discover capsular or vascular invasion.
Abstract: Ultrasound (US) elastography is a new non-invasive technique that uses ultrasounds to provide quantitative information about tissue stiffness. Two kinds of elastography (strain and shear wave elastography) are currently used in clinical practice. Although fine needle aspiration (FNA) is the most important procedure for the management of thyroid nodules, several studies have used US elastography as an adjunctive tool to conventional US, to differentiate malignant from benign nodules. In these studies malignant nodules are often associated with a greater elasticity scoring compared to benign. The conventional US plays an important role in defining which nodules are suitable for the US elastography because calcified and cystic nodules could be responsible for false positive and negative results respectively. On the other hand, follicular carcinoma gross anatomy and cellular pattern may resemble those of benign follicular adenoma. The histologic examination is often necessary to discover capsular or vascular invasion. Moreover, in contemporary literature there is disagreement about the role of US elastography in thyroid nodules with indeterminate or non-diagnostic cytology.
8 citations
TL;DR: This is the first report on extraction and analysis of cortisol levels in hard tissues, such as teeth, leading to the discovery of a novel biomarker that can be used when studying chronic stress.
Abstract: Objective: This study tests the feasibility and validity of analyzing cortisol levels within human teeth and the possibility of any potential gender differences.
Methods: As a precursor, to confirm the general presence and existence of cortisol within teeth, six healthy supernumerary teeth were initially extracted and examined following the ELISA method. After confirming that cortisol was in fact present within human teeth, we began the main experiment. In order to examine any potential gender differences, twenty-one extracted wisdom teeth were collected from subjects (11 male and 10 female) within the age range of 27-29 yrs.
Results: The results showed irrefutable proof of the existence of cortisol within the dentin of the teeth. Observations revealed that gender had no significant impact upon a subject’s dental cortisol levels (p>0.05), suggesting that cortisol in teeth can be used as an unbiased and reliable means of studying stress. Conclusions: This is the first report on extraction and analysis of cortisol levels in hard tissues, such as teeth, leading to the discovery of a novel biomarker that can be used when studying chronic stress. Practical application of this study can be used postmortem to assess cortisol levels in patients suffering from prolonged disorders, including patients having undergone chemotherapy treatments, when hair cortisol analysis proved to be problematic.
8 citations
TL;DR: For Mexicans, none of the polymorphisms were associated with a risk of developing obesity or T2D, however, there is an increased risk of developed obesity for the whole population for subjects who carry the g.-420G allele.
Abstract: Objective: To determine the association between the c.+62G>A and g.-420C>G polymorphisms and Type 2 Diabetes (T2D) or obesity susceptibility for Mexicans. Additionally, we examined their overall effect across different populations by a systematic review. Methods: 164 Mexicans were classified as Healthy, Obese, or T2D. Genotypes were determined and associated risk for the heterozygous, homozygous, dominant, recessive, and allelic genetic models were determined by calculating the Odds Ratios (OR). For the meta-analysis, original publications that had determined RETN polymorphisms in T2D or obese subjects were searched for in PubMed, Scopus, EBSCO, Ovid, and Wiley databases until November 2015, using the search terms: T2D, obesity, RETN, and polymorphism. Pooled ORs were computed using a random-effects or fixed-effects models. Results: For our cohort, no associations were observed between the polymorphisms and obesity or T2D. The metaanalysis indicates an increased risk of obesity among carriers of the g.-420G allele for the heterozygous and dominant models (OR=1.33 and OR=1.30, p<0.05, respectively). By regional assessment, Africans were associated with an elevated risk of developing T2D (OR=2.35-7.17, p<0.05) and obesity (OR=1.54-2.13, p<0.05). North Americans had an increased risk of developing obesity for the heterozygous and dominant models (OR=1.49and OR=1.42, p<0.05, respectively). No associations were determined between the c.+62 polymorphism and obesity or T2D. Conclusion: For Mexicans, none of the polymorphisms were associated with a risk of developing obesity or T2D. However, there is an increased risk of developing obesity for the whole population for subjects who carry the g.-420G allele.
7 citations
TL;DR: This review will study the structure, receptors, secretion factors, biological effects of prolactin in men, which indicates that the hypo-prolactinaemia in men is associated with infertility, erectile dysfunction, hypo function of the seminal vesicles, oligospermia and asthenospermies.
Abstract: The role of prolactin in women is quite documented while the man studies are conflicting. In this review we will study the structure, receptors, secretion factors, biological effects of prolactin in men. Previous studies in men associate hyper-prolactinemia with infertility, erectile dysfunction, reduced testosterone, decreased sexual desire as rarely galactorrhea. Originally had not been investigated low prolactin levels in the male but recent studies indicate that the hypo-prolactinaemia in men is associated with infertility, erectile dysfunction, hypo function of the seminal vesicles, oligospermia and asthenospermia. Recent studies indicated that 1 or 2 years after the bariatric surgery levels of the hormone prolactin reduced.
6 citations
TL;DR: Hypothyroidism is associated with insulin resistance, renal impairment, hyperurecemia and dyslipidemia, which are atherosclerotic risk indicators, thus patients with elevated TSH are at high risk of developing atherosclerosis, thus may need close monitor to contain the rise in plasma TSH.
Abstract: The overt and subclinical hypothyroidism is more prevalent in patients with diabetes mellitus than in general population. Recently, more studies have been warranted to elucidate the relationship between thyroid hormones disorders and the insulin activity. The present study aims to investigate the correlations between the thyroid hormone levels in subclinical and overt hypothyroid patients with the insulin resistance and their impact on serum lipid profiles and kidney function.
Methods: A total of fifty newly diagnosed hypothyroid patients were recruited for the study and classified into: 1) Subclinical hypothyroid (SH) group: n-26; 2) Overt hypothyroid (OH) group: n=24, and control (C) group: n=18. Fasting blood was collected and serum was used for biochemical analysis.
Results: The fasting serum insulin, glucose levels and the estimated insulin resistance index (HOMA) of the SH and OH groups were significantly (P<0.001) elevated compared to control. The regression analysis reviled a significant negative correlation between FT4 and insulin (r=-0.32, P=0.04) and significant positive correlations between TSH and insulin (r=0.57, P=0.002), between TSH and HOMA (r=0.51, P=0.001), between HOMA and uric acid (r=0.37, P=0.02), and between TSH and TG (r=0.47, P=0.002). The serum creatinine, urea and uric acid concentrations were significantly (P<0.001) elevated in the OH group but not the SH. The serum total cholesterol, TG and LDL-cholesterol were significantly elevated in both SH and OH.
Conclusion: Hypothyroidism is associated with insulin resistance, renal impairment, hyperurecemia and dyslipidemia, which are atherosclerotic risk indicators. The TSH had maximum impact on the changes. Subclinical and overt hypothyroid patients with elevated TSH are at high risk of developing atherosclerosis, thus may need close monitor to contain the rise in plasma TSH.
TL;DR: A case report of an adult granulosa cell tumor discovered fortuitously during caesarian section and the management of this tumor and the way to preserve the fertility are presented.
Abstract: Granulosa cell tumors of the ovary are rare ovarian malignancy developed on stromal ovarian cells and
characterized by estrogen secretion. Histologically, there are divided on two types: adult granulosa tumors, which
are more frequent and occurring in perimenopausal and post-menopausal women and juvenile granulosa tumors,
which are rarer and occurring in teenager and adolescent girls.
The association between GCT and pregnancy is a rare condition with therapeutic challenge consisting on the
pregnancy and the fertility outcome in a hand and the oncological results in the other.
We present a case report of an adult granulosa cell tumor discovered fortuitously during caesarian section. We
report the management of this tumor and the way to preserve the fertility.
TL;DR: Obesity is associated with many metabolic abnormalities like insulin resistance, impaired glucose tolerance, dyslipidemia, morphological and structural renal changes which may proceed to Glomerulosclrosis (GS) and CKD.
Abstract: Background and study aim: Obesity and concomitant co-morbidities have emerged as public health problems of the first order. Obese individuals have an increased risk for Chronic Kidney Disease (CKD). The aim of this study is to study the metabolic and early renal histopathologic changes that are associated with obesity in experimental animals. Materials and Methods: This study was conducted on sixty adult male albino rats; thirty with body weight ranging between 180-200 gm (control) beside thirty rates with body weight more than 250 gm. Control animals were fed a standard rat chow while obese rats were fed a semisynthetic diet enriched in sucrose. After 4 weeks, blood samples were collected to assess: Fasting Blood Glucose (FBG), Serum Insulin (SI), serum Total Lipid (TL), serum Triglyceride (TG), Total Cholesterol (TC), serum High Density Lipoprotein (HDL) and serum Low Density Lipoprotein (LDL). Kidney tissue samples were stained with Hematoxylin and Eosin, Anti-Collagen IV antibody then examined by light and electron Microscope. Results: There was a significant increased Body Weight (BW) and kidneys weight of obese group. There was a significant increased of FBS (p 0.0001), SI (p 0.0001), TL (p 0.0001), TC (p 0.0001), TG (p 0.0001), and LDL (p 0.0043) with significant decreased of HDL (p 0.0133) in obese group. Serum creatinine was significantly increased in obese group with a significant positive correlation between it and BW, FBS, SI, and TG. Histological examination revealed moderately expanded Bowman’s capsule, wide renal tubules, a positive reaction for collagen IV, increased thickness of glomerular basement membrane, foot processes fusion and many vacuolation in the cells lining of proximal convoluted tubules of obese rats kidneys. Conclusions: Obesity is associated with many metabolic abnormalities like insulin resistance, impaired glucose tolerance, dyslipidemia, morphological and structural renal changes which may proceed to Glomerulosclrosis (GS) and CKD.
TL;DR: Results suggest that reduction in MDA-LDL may be a predictor for reduction in SBP after a 12-week exercise in community-dwelling persons.
Abstract: Introduction: Blood pressure (BP) is one of the most significant manifestations of aging and vascular disease. Oxidative stress is thought to be involved in the development of vascular dysfunction, however, the effect on baseline and changes in peripheral BP is unknown. We investigated whether baseline and changes in the oxidative stress marker, malondialdehyde-modified low density lipoprotein (MDA-LDL) are associated with baseline and change in BP, by a 12-week exercise among Japanese community-dwelling persons.
Methods: The subjects comprised 10 men and 76 women aged 70 ± 7 (range, 61-82) and 67 ± 7 (range, 53-81) years, respectively. Before and at the end of the 12-week training program, metabolic variables including MDA-LDL, and systolic BP (SBP) anddiastolic BP (DBP) were obtained.
Results: Gender, baseline TG, and MDL-LDL correlated significantly with baseline SBP; gender, age, BMI, TG, MDA-LDL, hsCRP, GGT, and HMA-IR correlated significantly with DBP. Stepwise linear regression analysis for baseline BP status showed that baseline BMI and MDA-LDL are significantly and independently associated with SBP, and age while baseline GGT significantly and independently associated with DBP. After the 12-week Nordic walking exercise, change in MDA-LDL significantly correlated with changes in SBP and DBP. Stepwise multivariate linear regression analysis for changes in BP parameters showed that reduction in MDA-LDL was significantly and independently associated with reduction in SBP.
Conclusions:These results suggest that reduction in MDA-LDL may be a predictor for reduction in SBP after a 12-week exercise in community-dwelling persons.
TL;DR: The MetS risk differed by sex in Korean adults and was markedly high in older women, especially for middleaged and elderly women.
Abstract: Objective: We examined sex differences in the risk of metabolic syndrome (MetS) and its diagnostic components among Korean adults.
Methods: A total of 17,826 adults (7,061 men, 10,765 women) aged 19+ years with no diagnosed chronic diseases, such as diabetes, hypertension, or dyslipidemia were selected from the 2008-2012 Korea National Health and Nutrition Examination Survey data. MetS was classified by the National Cholesterol Education Program Adult Treatment Panel III criteria with the Asia-Pacific specific cut-off for excessive waist circumference. All statistical analyses accounted for the complex sampling design effect and used appropriate sample weights.
Results: The overall prevalence of MetS was slightly higher in men (19.0%) than in women (14.8%). The prevalent diagnostic components were elevated triglycerides (33.2%) in men whereas low HDL-cholesterol (44.9%) and excessive waist circumference (31.3%) in women. The prevalence of MetS increased with age only in women. Women < 60 years had a lower prevalence of MetS than men in the same age category but the prevalence in women surpassed that in men after 60 years. There were differences in common combinations of MetS diagnostic components between men and women.
Conclusion: The MetS risk differed by sex in Korean adults and was markedly high in older women. Our findings warrant specific preventive strategies and clinical managements for MetS according to sex, especially for middleaged and elderly women.
TL;DR: The study proved that the components of metabolic syndrome, especially abdominal obesity, hypertriglyceridemia, and impaired fasting glucose have a major impact on the level of LDL and non-HDL-C, which is associated with a higher cardiovascular risk.
Abstract: In 1988 Reaven described polymorphic metabolic abnormalities involving the incidence of insulin resistance with compensatory hyperinsulinemia, type 2 diabetes mellitus, arterial hypertension and hypercholesterolemia also known as Reaven’s syndrome or syndrome X. The aim of the study was to evaluate if cardiovascular risk in patients with metabolic syndrome [MetS] correlate with LDL-C and non-HDL-C levels. The study was a prospective, twocenter screening study of 36-month duration located in University Hospital No.1 in Bydgoszcz, Poland and District Hospital in WA„Â…brzezno, Poland. The study included 906 participants (460 females [F], 446 males [M], aged 32-76 years), with a confirmed diagnosis of metabolic syndrome according to the 2005 IDF criteria. The study showed that LDL-C and non-HDL-C levels are connected with increased level of triglycerides and impaired fasting glucose. Levels of LDL-C and non-HDL-C also influenced hypertension and hypoalfalipoproteinemia to a lesser extent and exerted the least influence in individuals with type 2 diabetes mellitus. The study proved that the components of metabolic syndrome, especially abdominal obesity, hypertriglyceridemia, and impaired fasting glucose have a major impact on the level of LDL and non-HDL-C, which is associated with a higher cardiovascular risk.
TL;DR: Risk of breast cancer and recurrence is increased by Metabolic syndrome, which can get improved in patients with breast cancer by regular exercise or physical activity.
Abstract: Risk of breast cancer and recurrence is increased by Metabolic syndrome. Metabolic syndrome can get improved in patients with breast cancer by regular exercise or physical activity.
TL;DR: All elements that should be considered when diagnosing bone mineral density diminished for age are described and mention is made of diseases which must be ruled out by clinical and biochemical parameters.
Abstract: Since the endorsed use of pediatric bone software to assess bone mass through DXA in the 1990s, some concepts have been established to arrive at a correct interpretation of bone mineral density in this population. This review describes all elements that should be considered when diagnosing bone mineral density diminished for age. The use of the Z-score instead of the T-score and the history of bone fractures (only fractures of long bones and vertebral crushing are considered clinically relevant) are discussed. The evaluation of BMD (Bone Mineral Density) values by DXA according to pubertal stage, sex, and bone age is clarified. In addition mention is made of diseases which must be ruled out by clinical and biochemical parameters; the latter vary according to age and sex, so that the normal reference value for adults should not be used.
TL;DR: The review summarizes the various aspects of the role of vistafin as biomarker of MetS compared with commonly used biomarkers, i.e. adiponectin, leptin, resistin, apelin.
Abstract: Vistafin is insulin-mimicking adipocytokine secreted from visceral adipose tissue, which plays an essential role in a number of biological processes affected glucose uptake regulation, inflammation, immunity, insulin resistance, vascular calcification, capillary tube formation, endothelial cell function and angiogenesis. Circulating level of visfatin exhibits to be a sufficiently increased in MetS and Type 2 Diabetes Mellitus (T2DM) patients compared with healthy individuals. Several clinical studies have shown that serum vitafin may predict Cardiovascular (CV) disease and CV events in MetS and T2DM patients. The review summarizes the various aspects of the role of vistafin as biomarker of MetS compared with commonly used biomarkers, i.e. adiponectin, leptin, resistin, apelin. In future more investigations are needed to better understand the role of vistafin in dysmetabolic-related disease and its ability to predict CV complications in these patient population
TL;DR: An additional and unique case in a 70 year old woman who had an incidentally discovered ectopic adrenal tissue that gave rise to an adrenal cortical adenoma in the setting of adrenal-renal fusion is described.
Abstract: Adrenal-renal fusion is a rare developmental anomaly in which adrenal tissue extends into the renal parenchyma without separate encapsulation of the two organs. Of the few cases described in the literature, clinically significant adrenal-renal fusion has been associated with adrenal cortical adenomas, which appear to be solid masses with enhancing and infiltrative features on radiographic studies. Only three cases of adrenocortical adenoma associated to adrenal-fusion have been published. We describe an additional and unique case in a 70 year old woman who had an incidentally discovered ectopic adrenal tissue that gave rise to an adrenal cortical adenoma in the setting of adrenal-renal fusion.
TL;DR: It is concluded that GLP-1 mediated agents are promising treatment strategies in the management of obese PCOS, however, larger sample size studies with longer durations of treatment may be required to examine potential benefits of these medications in decreasing metabolic risk and improving reproductive outcome in obesePCOS.
Abstract: Obesity is frequently present in women with polycystic ovary syndrome (PCOS). It aggravates the adverse features of the syndrome and increases the metabolic risk in this population. Weight management by lifestyle intervention often remains unsatisfactory and non-sustainable. In the present mini review we revised limited studies addressing the potential use of agents mediating through GLP-1 in PCOS. We reported that short-term intervention with long acting GLP-1 analogue liraglutide is associated with consistent BMI decrease in treatment naive obese women with PCOS and in those who had been previously poor responders to metformin and lifestyle modification. Metformin, a well-established therapy used in PCOS with high metabolic risk, was recognized as a mechanistically well-suited combination with liraglutide. Short-term intervention with liraglutide also improved eating behavior in obese PCOS. Furthermore, we discussed the potential association of genetic variability of GLP-1 receptor and interindividual differences in response to liraglutide regarding weight reduction. In addition, we challenged the original concept related to the enhancement of GLP-1 mediated action through phosphodiesterase 4 (PDE 4) inhibitions as a new potential therapeutic target in obesity-related population. We concluded that GLP-1 mediated agents are promising treatment strategies in the management of obese PCOS. However, larger sample size studies with longer durations of treatment may be required to examine potential benefits of these medications in decreasing metabolic risk and improving reproductive outcome in obese PCOS.
TL;DR: Evaluating the programs’ competency providing basic qualifications aimed through theory, practice and extra field courses in Turkey found majority of the stakeholders agreed the programs should include more practice courses on work-related knowledge and skills.
Abstract: Aim: Universities responsive to social changes can change rapidly and correctly and reflect these changes in the Programs and institutions that are intertwined with society. Program development, in accordance with the requirements of the profession, is integrated with program evaluation studies. The objective of the present study is to evaluate expectation sand needs of stakeholders of Nutrition and Dietetic programs in Turkey.
Methods: Thirty-four Nutrition and Dietetics programs in Turkey were analysed qualitatively in terms of their historical background, present status, program structure, and knowledge and skills offered through courses. After identification of the stakeholders (participants) of the programs, they were given questionnaires and interviews to provide their opinions about the program. The total number of participants in the present study was 408; 34.3% are students, 22.1% are dietitians, 17.2% are patients and clients, 13% are instructors, 12.2% are cooks and waiters, and 1.2% are managers.
Results: There was a statistically significant difference (P<0.05) among students, dietitians and instructors in Evaluating the programs’ competency providing basic qualifications aimed through theory, practice and extra field courses. The same difference occurred for the degree they find important skills and knowledge for the profession. Majority of the stakeholders agreed the programs should include more practice courses on work-related knowledge and skills.
Conclusions: Programs should be reviewed in accordance with the needs and expectations of stakeholders. Segments of society affected by the program should actively participate in future program studies.
TL;DR: There are billions of people who pretend to impose their lack of awareness and fight against novelties and treatments they do not understand, but the wishful, unaware thinking of billions rejects the least appealing solution as false or insufficiently proved.
Abstract: According to Feinman and Einstein I consider Science as a truth or a collection of (visual) images developing in space and time that are connected by symbols, generally words. About the same object, people show a cross-sectional variability in their mental reproductions and even the same person shows a longitudinal variability. These mental developments allow prediction of the next events, e.g. what we shall find around the corner. The variability is high in the correspondence of the predicted events versus the actual events. The coincidence degree represents the value of a given “truth” and the reliability of a person. Many physicians may assert a prognosis from the current state of an ill patient, from personal experience and science. I presume to know the development of diabetes: this development goes on for years with the help of physicians. The patient requires more and more insulin to allocate energy in increasing fatty stores. Insulin is given sometimes directly by injections or indirectly by drugs stimulating production. A project for a never ending body weight increase! Why am I blaming this strategy? [1-4] Why Medical Sciences show big cross-sectional differences in the pathogenesis and treatment that we do not see in the physicists’ rules? The physicists have areas of uncertainty that are far beyond the surface! I have an explanation that might even become a truth if many scientists would agree. Physicians have to share the products of research with patients they have to encourage patients to start a novel path with some risks The researcher remains usually far from the conflicts of interest, but the treatment has to be acceptable and understandable: joint pain must be treated by local changes in activity, posture, work load, rest, heat etc. and not by control of energy intake [5-11]. There are billions of people who pretend to impose their lack of awareness and fight against novelties and treatments they do not understand. Patients want unchanged customs and want to consume the staple food, even if there is no more need [12-17]. Drugs have to be found to overcome the second principle of Thermodynamics with unremitting failures. Exploitation of physiology adaptations are the healthiest solution [13,18]. In this direction, only physical activity is largely exploited but this sole intervention is insufficient to stop general fattening [12]. Although difficult, intake adaptations are most effective to achieve an even energy balance [6-12]. Drugs are mysterious, magic, constitute the simplest solution and are sustained by investigations on huge numbers of subjects. In contrast to Prigogine (research does not deceive) the wishful, unaware thinking of billions rejects the least appealing solution as false or insufficiently proved.
TL;DR: A rare case of 46 year old female with premature menopause and symptom of hair loss, who had high testosterone levels and left ovary mass and an ovarian source of androgen was suspected, is reported for its rare nature and atypical presentation.
Abstract: Mild hirsutism and alopecia in postmenopausal women can be a normal physiological response. Sex cord stromal tumors of ovary account for approximately 5-8% of all ovarian tumors. When hirsutism is accompanied by signs of virilization such as severe balding, deepening of voice or clitoromegaly, an underlying androgen-secreting tumor, that may be malignant must be ruled out. We report a rare case of 46 year old female with premature menopause and symptom of hair loss. She had high testosterone levels and left ovary mass. As Cushing syndromes and late onset congenital adrenal hyperplasia were ruled out, an ovarian source of androgen was suspected. She underwent hysterectomy with bilateral salpingo-oophorectomy. A diagnosis of left ovarian sex-cord stromal tumor favoring Sertoli-Leydig cell tumor was confirmed. We report this case for its rare nature and atypical presentation.
TL;DR: Osteitis fibrosa cystica although rare should be considered in the differential diagnosis of patients presenting with multiple brown tumors, especially since the diagnosis can be easily made by a simple calcium level, thereby avoiding severe adverse outcomes.
Abstract: Introduction: The classical presentation of primary hyperparathyroidism, osteitis fibrosa cystica, has become very rare nowadays. This rarity makes it sometimes misdiagnosed leading to disastrous outcomes.
Methods: We present a case of an undiagnosed primary hyperparathyroidism with severe osteitis fibrosa cystica and brown tumors that was first misdiagnosed as having bone metastasis.
Conclusion: Osteitis fibrosa cystica although rare should be considered in the differential diagnosis of patients presenting with multiple brown tumors, especially since the diagnosis can be easily made by a simple calcium level, thereby avoiding severe adverse outcomes.
TL;DR: Thrombomodulin and sEPCR as prothombotic agents did not show any indication that they can be utilised as markers for the prevention and/or treatment of thrombotic complications in diabetic patients, and could serve as indicators for renal damage in diabetics but not in healthy individuals.
Abstract: Objective: To evaluate specific factors of coagulation and endothelial inflammatory markers namely, thrombomodulin, soluble receptor of the protein C (sEPCR), factor VIII, plasminogen activator inhibitor 1, Von Willebrandt factor, fibrinogen, fibrinogen dimers (d-dimers), high sensitivity C-reactive protein and homocysteine in a subset of Greek subjects with and without Type 2 (T2) Diabetes. Design: 84 subjects, of which 44 patients with T2 diabetes, were included in the randomized comparative prospective cross sectional study. The subjects were split into a Τ2 diabetics group and a group of healthy controls of similar age, anthropometric profiles and similar gender distribution.
Results: A total of 47 variables and biomarkers together with indicators for metabolic profiles, clinical history, as well as detailed anthropometric profiles and traditional risk factors, were evaluated. Dipeptidyl peptidase-4 (DPP4), Insulin, use of Sulfonylurea, high HBA1c and glucose levels, were clearly statistically differentiated in the two groups, while no other biomarkers including the new potential indicators were found to be different. High values of thrombomodulin and homocysteine were correlated with a rise in creatinine and thus seem to affect renal function in the diabetic patients group while in the non-diabetics group the correlations are different with sEPCR having a relative strong negative correlation in renal function as measured with The Modification of Diet in Renal Disease, in agreement with the latest international findings.
Conclusions: The presence of T2 diabetes in conjunction with age clearly correlates with problems in renal function, thrombomodulin and homocysteine could serve as indicators for renal damage in diabetics but not in healthy individuals. sEPCR on the other hand could be a potential generic indicator for renal damage. Thrombomodulin and sEPCR as prothombotic agents, did not show any indication that they can be utilised as markers for the prevention and/or treatment of thrombotic complications in diabetic patients.
TL;DR: A case of 40 year-old lady who presented with a 16 year history of generalized fatigue and recurrent episodes of hypoglycemia is described, which shows the impact of delay in the diagnosis of an easily treatable medical condition and its consequences, especially for the population of a developing country like Ethiopia.
Abstract: We described a case of 40 year-old lady who presented with a 16 year history of generalized fatigue and recurrent episodes of hypoglycemia. She had a complete clinical evaluation, endocrine studies, and a pituitary magnetic resonance scans that revealed pan-hypopituitarism secondary to Sheehan’s syndrome. She was given hormone replacement therapy, which led to a significant improvement in lethargy, anorexia, muscle weakness, and episodes of hypoglycemia. This case shows the impact of delay in the diagnosis of an easily treatable medical condition and its consequences, especially for the population of a developing country like Ethiopia
TL;DR: A neuroendocrine therapy with MLT and other pineal hormones could constitute a new strategy in cancer treatment, either as a substitutive therapy of cancer-related MLT diminished endogenous production, or to employ its antitumor pharmacological properties.
Abstract: Several experimental studies have demonstrated the existence of a natural immunobiological resistance cancer growth, which is mediated by both immune and neuroendocrine mechanism. Moreover, further researches have shown that the pineal gland plays a fundamental role in the natural antitumor resistance, by representing the most important anti-cancer organ in the human body. The anticancer property of the pineal gland is due to the production of several anticancer molecules, including the indole hormone melatonin (MLT), which represent the most investigated pineal hormone, other indoles, such as the 5-methoxytryptamine, and beta-carbolines. MLT has been proven to play anticancer activity through several mechanisms, consisting of cytotoxic antiproliferative action and stimulation of the anticancer immunity, by promoting IL-2 production by T helper lymphocytes and IL-12 secretion by dendritic cells. Cancer-progression has appeared to be associated with a progressive decline in MLT nocturnal production. Then, the pineal failure would constitute the main cancer-related endocrine deficiency. Preliminary clinical studies have demonstrated that MLT therapy at mild pharmacological doses may prolong the survival time of metastatic cancer patients, for whom no other effective standard therapy was available, and improve their clinical status. Therefore, a neuroendocrine therapy with MLT and other pineal hormones could constitute a new strategy in cancer treatment, either as a substitutive therapy of cancer-related MLT diminished endogenous production, or to employ its antitumor pharmacological properties.
TL;DR: In Chinese children, a heterozygous mutation of c.1030G>C in THRB gene may cause RTHS, and this mutation was found in exon 10 of TH RB gene resulting in an amino acid substitution, G344R, in the encoded protein.
Abstract: Background: Resistance to thyroid hormone (RTH), is a rare genetic disease. The aim of this research is to study a pediatric case of resistance to thyroid hormone (RTH) and its clinical manifestation. Methods: An infant demonstrating resistance to thyroid hormone (RTH) and her parents were subjected to THRB gene analysis by PCR amplification of peripheral blood DNA. The sequences were aligned and compared. Results: A heterozygous mutation, c.1030G>C, was found in exon 10 of THRB gene resulting in an amino acid substitution, G344R, in the encoded protein. Conclusion: In Chinese children, a heterozygous mutation of c.1030G>C in THRB gene may cause RTHS.
TL;DR: Much attention should be paid to patients with giant ovarian tumors who confined to bed more than 50% of waking hours (PS 3 or 4), and aggressive surgery is recommended due to a frequent incidence of cancer.
Abstract: Objectives: The aim of this study was to evaluate the relation between pathology, operative complications and giant ovarian tumor weighing more than 5,000 g. Materials and Methods: We assessed eleven factors of 18 patients with giant ovarian tumors after surgery, including age, Performance Status (PS), total weight of the tumor, fluid weight of the tumor, pathology, side, preoperative serum D-dimer, rate of Deep Venous Thrombosis (DVT), intraoperative complications (rate of intra-abdominal adhesion and blood loss weight), and rate of postoperative ICU management. The subjects were divided into two groups: tumor weight ≥10,000 g (group ≥10,000 g) and tumor weight <10,000 g (group <10,000 g), and the same factors were compared between two groups. Results: The most frequent pathology of giant ovarian tumors weighing more than 5,000 g was found to be adenocarcinoma. Compared with eleven patients of group<10,000 g, seven patients out of group ≥10,000 g had significantly higher PS (median: 3 vs. 1, p<0.05), rate of intra-abdominal adhesion (85.7% vs. 9.0%, p<0.05), fluid weight (15.000 g vs. 4.400 g, p<0.05), blood loss weight (890 g vs. 130 g, p<0.05), and rate of postoperative ICU management (85.7% vs. 18.2%, p<0.05), respectively. Conclusions: Much attention should be paid to patients with giant ovarian tumors who confined to bed more than 50% of waking hours (PS 3 or 4), and aggressive surgery is recommended due to a frequent incidence of cancer.