Macrosomia is defined as a term birth weight greater than or equal to 4000 grams, or greater than the 90 percentile of intrauterine growth curves. Excessive weight has harmful consequences for the newborn and is a maj...Macrosomia is defined as a term birth weight greater than or equal to 4000 grams, or greater than the 90 percentile of intrauterine growth curves. Excessive weight has harmful consequences for the newborn and is a major health concern. Objectives: To determine the frequency of neonatal macrosomia, describe risk factors and neonatal and maternal complications. Materials and methods: This was a cross-sectional study carried out between January and December 2022, involving newborns whose birth weight was greater than or equal to 4000 grams admitted to the neonatology unit of the Labe regional hospital. Results: 591 deliveries were recorded, 15 of which were macrosomic, representing a frequency of 2.54%. The average age of the women was 30.26 years. History of fetal macrosomia and diabetes was 93.33 and 71.43% respectively. The mean gestational age was 38.71 ± 0.75 SA, the mean antenatal consultation was 3 ± 0.8 and the mode of delivery was caesarean section (66.67%). Third-trimester ultrasound was performed in 53.33% of cases. Macrosomic newborns were male in 80% of cases. Neonatal complications were asphyxia (60%), hypoglycemia (20%) and hypocalcemia (13.33%). Factors associated with neonatal macrosomia were diabetes (P < 0.001), history of macrosomia (P Conclusion: this study shows that the frequency of neonatal macrosomia is 2.54% with high neonatal morbidity among newborns hospitalized in the neonatology unit of the Labé regional hospital. Screening for macrosomia risk factors during pregnancy is essential to prevent perinatal complications.展开更多
In recent years the treatment focus for type 2 diabetes has shifted to prevention by lifestyle change and to more aggressive reduction of blood sugars during the early stage of treatment. Weight reduction is an import...In recent years the treatment focus for type 2 diabetes has shifted to prevention by lifestyle change and to more aggressive reduction of blood sugars during the early stage of treatment. Weight reduction is an important goal for many people with type 2 diabetes.Bariatric surgery is no longer considered a last resort treatment. Glucagon-like peptide-1 agonists given by injection are emerging as a useful treatment since they not only lower blood sugar but are associated with a modest weight reduction. The role of the oral dipeptidyl peptidase 4 inhibitors is emerging as second line treatment ahead of sulphonylureas due to a possible beneficial effect on the beta cell and weight neutrality.Drugs which inhibit glucose re-absorption in the kidney,sodium/glucose co-transport 2 inhibitors, may have a role in the treatment of diabetes. Insulin treatment still remains the cornerstone of treatment in many patients with type 2 diabetes.展开更多
AIM:To analyze the risk of coronary heart disease in patients with type 2 diabetes mellitus(T2DM)receiving standard medical treatment.METHODS:We performed a retrospective chart analysis of 269 middle-aged patients(age...AIM:To analyze the risk of coronary heart disease in patients with type 2 diabetes mellitus(T2DM)receiving standard medical treatment.METHODS:We performed a retrospective chart analysis of 269 middle-aged patients(age 45-64 years,mean age,53.9±5.5 years)with T2DM and without atherosclerotic cardiovascular events who underwent typing to determine their apolipoprotein E(apoE)isoforms.The apoE isoforms were determined using isoelectric focusing,followed by immunoblotting.We retrospectively evaluated the charts of the 269 patients,recorded between their first visit to the hospital(the study's start point,between 1987 and 1992)and the occurrence of an atherosclerotic cardiovascular event(the study's endpoint)or January 2004,whichever came first.The age-adjusted mean values and the prevalences of covariates were calculated to compare the laboratory data among the apoE phenotypes.To investigate the association of risk factors with the incidence of coronary heart disease during the follow-up period,monovariate and multivariate Cox regression models were used.RESULTS:At enrollment,the mean serum low density lipoprotein(LDL)cholesterol levels were lowest(2.92± 0.89 mmol/L)among the subjects with apoE2(apoE2/2 or apoE2/3)and highest(3.52±0.77 mmol/L)among the subjects with apoE4(apoE3/4 or apoE4/4).No significant differences in mean age or the percentage of smokers were observed among the three groups.Furthermore,no significant differences were observed in the systolic and diastolic blood pressures,body mass index,HbA1c level or serum triglyceride levels among the three groups.There were 47 cases of coronary heart disease over 3285 person-years of follow-up.An age-adjusted multivariate Cox proportional model identified diabetic retinopathy(hazard ratio,2.38,95% CI:1.28-4.43,P=0.006),a high systolic blood pressure(hazard ratio,1.04,95%CI:1.02-1.06,P<0.001) and high HbA1c values(hazard ratio,1.19,95%CI:1.02-1.38,P=0.0029),but not the LDL cholesterol value at enrollment(hazard ratio,1.01,95%CI:0.97-1.05,P=0.77)nor the specific apoE isoform,as significant predictors of coronary heart disease.CONCLUSION:Under standard medical treatment of diabetes,including the control of LDL cholesterol levels,the apoE4 isoform was not associated with coronary heart disease among T2DM patients.展开更多
Both GLP-1 receptor agonists(GLP-1RA)and SGLT-2 inhibitors(SGLT-2I)are newer classes of anti-diabetic agents that lower HbA1c moderately and decrease body weight and systolic blood pressure(SBP)modestly.Combination th...Both GLP-1 receptor agonists(GLP-1RA)and SGLT-2 inhibitors(SGLT-2I)are newer classes of anti-diabetic agents that lower HbA1c moderately and decrease body weight and systolic blood pressure(SBP)modestly.Combination therapy with GLP-1RA plus SGLT-2I have shown a greater reduction in HbA1c,body weight,and SBP compared to either agent alone without any significant increase in hypoglycemia or other side effects.Since several agents from each class of these drugs have shown an improvement in cardiovascular(CV)and renal outcomes in their respective cardiovascular outcome trials(CVOT),combination therapy is theoretically expected to have additional CV and renal benefits.In this comprehensive opinion review,we found HbA1c lowering with GLP-1RA plus SGLT-2I to be less than additive compared to the sum of HbA1c lowering with either agent alone,although body weight lowering was nearly additive and the SBP lowering was more than additive.Our additional meta-analysis of CV outcomes with GLP1RA plus SGLT-2I combination therapy from the pooled data of five CVOT found a similar reduction in three-point major adverse cardiovascular events compared to GLP-1RA or SGLT-2I alone,against placebo.Interestingly,a greater benefit in reduction of heart failure hospitalization with GLP-1RA plus SGLT-2I combination therapy was noted in the pooled meta-analysis of two randomized controlled trials.Future adequately powered trials can confirm whether additional CV or renal benefit is truly exerted by GLP-1RA plus SGLT-2I combination therapy.展开更多
Cardiovascular disease(CVD) is the leading cause of morbidity and mortality among patients with diabetes mellitus,who have a risk of cardiovascular mortality two to four times that of people without diabetes.An indivi...Cardiovascular disease(CVD) is the leading cause of morbidity and mortality among patients with diabetes mellitus,who have a risk of cardiovascular mortality two to four times that of people without diabetes.An individualised approach to cardiovascular risk estimation and management is needed.Over the past decades,many risk scores have been developed to predict CVD.However,few have been externally validated in a diabetic population and limited studies have examined the impact of applying a prediction model in clinical practice.Currently,guidelines are focused on testing for CVD in symptomatic patients.Atypical symptoms or silent ischemia are more common in the diabetic population,and with additional markers of vascular disease such as erectile dysfunction and autonomic neuropathy,these guidelines can be difficult to interpret.We propose an algorithm incorporating cardiovascular risk scores in combination with typical and atypical signs and symptoms to alert clinicians to consider further investigation with provocative testing.The modalities for investigation of CVD are discussed.展开更多
BACKGROUND Type 2 diabetes mellitus(T2DM)is a risk factor for nonalcoholic fatty liver disease(NAFLD).AIM To determine the prevalence and clinical correlates of NAFLD in a large cohort of patients with T2DM.METHODS Fo...BACKGROUND Type 2 diabetes mellitus(T2DM)is a risk factor for nonalcoholic fatty liver disease(NAFLD).AIM To determine the prevalence and clinical correlates of NAFLD in a large cohort of patients with T2DM.METHODS Four hundred thirty-seven participants with T2DM who consulted at Meijo Hospital from April 2019 to September 2020 and underwent computed tomography(CT)were assessed.The mean age was 74±13 years,and 269 were men.Hepatic attenuation minus splenic attenuation(CTL−S)less than 1 Hounsfield unit was considered fatty liver.NAFLD was defined as fatty liver in the absence of significant alcohol consumption and hepatitis virus infection.A multiple logistic regression was used to assess the independent factors associated with NAFLD.RESULTS NAFLD was identified in 25.2%of the participants.Young age(odds ratio[OR]=−0.945;95%confidence interval[CI]:0.922–0.969),higher hemoglobin levels(OR=1.501,95%CI:1.278–1.764),lower high-density lipoprotein(HDL)cholesterol levels(OR=0.971,95%CI:0.953–0.989),and the absence of dialysis(OR=0.109,95%CI:0.014–0.856)were independent predictors of NAFLD.CONCLUSION NAFLD was detected with CT in 25.2%of the participants.NAFLD was associated with younger age,higher hemoglobin levels,lower HDL cholesterol levels,and an absence of dialysis.展开更多
<strong>Background:</strong> Although the frequencies of getting drug naive type 2 diabetes patients among all the diabetic patients are very low, nowadays it claims more attention in the treatment procedu...<strong>Background:</strong> Although the frequencies of getting drug naive type 2 diabetes patients among all the diabetic patients are very low, nowadays it claims more attention in the treatment procedures of drug naive diabetic patients. But in Bangladesh, we have very few research-oriented data regarding the demographic, clinical and biochemical characteristics of drug naive type 2 diabetes patients. The aim of this study was to determine the demographic clinical and biochemical characteristics of drug naive type 2 diabetes patients of Bangladesh. <strong>Methods: </strong>This was an open label observational real-life study which was conducted in the chambers of the investigators in several places of Bangladesh as outdoor setting during the period from August 2020 to December 2020. In total, 250 patients with drug naive type 2 diabetes mellitus were enrolled as the study population. Proper written consents were taken from all the participants before starting data collection. A pre-designed questionnaire was used in patient data collection. All data were processed, analyzed and disseminated by MS Office and SPSS version as per need. <strong>Result:</strong> Two hundred and fifty (250) participants were selected as study population. The male-female ratio of the participants was 1.4:1. The highest number of participants was from 51 - 60 years’ age group (31.20%). The highest number of participants (41%) was with overweight (BMI: 25 - 30 kg/m<sup>2</sup>). Majority (65%) of the patients of this study suffered from diabetes for ≤5 years. The mean (±SD) SBP of the participants was 137.25 ± 17.50 mmHg and the mean (±SD) DBP of the participants was 85.16 ± 13.39 mmHg. We found the mean (±SD) fasting blood sugar (mg/dl), post prandial blood sugar (mg/dl), total cholesterol (mg/dl), triglycerides (mg/dl), HDL-Cholesterol (mg/dl), LDL-cholesterol (mg/dl), VLDL-cholesterol (mg/dl), uric acid (mg/dl), creatinine (mg/dl), urea (mg/dl), total bilirubin (mg/dl), direct bilirubin (mg/dl), SGOT (IU/L) and SGPT (IU/L) were 251.51 ± 112.08, 349.72 ± 128.68, 219.59 ± 68.25, 196.44 ± 94.34, 35.14 ± 11.85, 145.72 ± 64.33, 40.88 ± 18.12, 3.45 ± 1.51, 0.86 ± 0.37, 29.16 ± 9.81, 0.87 ± 0.4, 0.48 ± 0.4, 37.15 ± 10.9 and 35.83 ± 23.04 respectively. <strong>Conclusion:</strong> Obesity and hypertension demand more attention of diabetologists in diagnosis and treatment of patients or suspected patients of diabetes. Patients aged ≥ 50 years are most vulnerable and suspicious for diabetes. Besides age consequence habits of tobacco smoking, family history, smoking and HTN, alcohol intake and presence of nitrites in the urine may be considered as the most potential comorbidities for diabetic patients. Diagnosis of demographic, clinical and biochemical characteristics of drug naive type 2 diabetes patients may play a vital role in proper treatment.展开更多
Background:During the clinical use of Jiangtangjing granules,we have found that they improve glucose metabolism and relieve symptoms in patients with type 2 diabetes mellitus.We aimed to further investigate the hypogl...Background:During the clinical use of Jiangtangjing granules,we have found that they improve glucose metabolism and relieve symptoms in patients with type 2 diabetes mellitus.We aimed to further investigate the hypoglycemic effects of Jiangtangjing granules and the mechanisms involved.Methods:Type 2 diabetes mellitus was induced in rats by high-fat diet feeding and streptozotocin injection.The rats were then orally administered Linagliptin(3 mg/kg)or Jiangtangjing granules(13 g crude preparation/kg)for 4 weeks.The therapeutic effects of Jiangtangjing granules on glucose metabolism were then investigated.The serum glucagon-like peptide-1,insulin and glycosylated hemoglobin concentrations were measured using enzyme linked immunosorbent assay.Immunohistochemistry and quantificational real-time polymerase chain reaction were performed to quantify glucagon-like peptide-1 protein expression and cAMP,protein kinase A,and Epac1 mRNA expression,respectively.In addition,amplicon sequencing of bacterial 16s rDNA genes in rat feces was also performed to analyze the richness and diversity of the intestinal microbiota and to determine the relative abundances of the dominant bacterial phyla in the intestinal contents of the rats.Results:Jiangtangjing reduced fasting blood glucose concentration(P<0.05)and blood glucose concentrations during oral glucose tolerance testing(P<0.01),increased serum glucagon-like peptide-1 concentration after glucose administration(P<0.05)and improved glucose tolerance(P<0.05).It also increased glucagon-like peptide-1 protein expression(P<0.05)and the mRNA expression of cAMP(P<0.05),PKA(P<0.05),and Epac1(P<0.05)in the jejunum.Jiangtangjing also affected the composition of the intestinal microbiota in rats with type 2 diabetes mellitus.Specifically,it increased the relative abundance of Bacteroides and reduced that of Actinobacteria.Conclusion:Jiangtangjing granules have anti-diabetic effects,increasing circulating insulin concentration and glucose tolerance.These effects may be mediated by increases in glucagon-like peptide-1 secretion via upregulation of the cAMP/PKA signaling pathway in the jejunum and alterations in the composition of the intestinal microbiota.展开更多
Diabetes mellitus is a complex condition with far reaching physical, psychological and psychosocial effects. These outcomes can be significant when considering the care of a youth transferring from paediatric through ...Diabetes mellitus is a complex condition with far reaching physical, psychological and psychosocial effects. These outcomes can be significant when considering the care of a youth transferring from paediatric through to adult diabetes services. The art of mastering a smooth care transfer is crucial if not pivotal to optimising overall diabetic control. Quite often the nature of consultation varies between the two service providers and the objectives and outcomes will mirror this. The purpose of this review is to analyse the particular challenges and barriers one might expect to encounter when transferring these services over to an adult care provider. Particular emphasis is paid towards the psychological aspects of this delicate period, which needs to be recognised and appreciated appropriately in order to understand the particular plights a young diabetic child will be challenged with. We explore the approaches that can be positively adopted in order to improve the experience for child, parents and also the multi- disciplinary team concerned with the overall delivery of this care. Finally we will close with reflection on the potential areas for future development that will ultimately aim to improve long-term outcomes and experiences of the young adolescent confronted with diabetes as well as the burden of disease and burden of cost of disease.展开更多
BACKGROUND Omarigliptin is one of several once-weekly dipeptidyl peptidase-4 inhibitors(DPP-4is).Despite the high frequency of switching from various daily DPP-4is to omarigliptin in actual clinical practice,data rega...BACKGROUND Omarigliptin is one of several once-weekly dipeptidyl peptidase-4 inhibitors(DPP-4is).Despite the high frequency of switching from various daily DPP-4is to omarigliptin in actual clinical practice,data regarding its efficacy in patients with type 2 diabetes(T2D)after switching are limited.AIM To analyze the efficacy of omarigliptin in Japanese patients with T2D who had previously received treatment with other glucose-lowering agents.METHODS Forty-nine T2D patients treated for the first time with omarigliptin were recruited retrospectively and divided into four groups defined as either add-on or switched from daily DPP-4is:switched from linagliptin,switched from sitagliptin,and switched from vildagliptin.During a 3-mo follow-up,the clinical parameters among these groups were assessed and compared,with the impact of the switch on glycemic variability as measured by continuous glucose monitoring also being evaluated in the switched groups.RESULTS Hemoglobin A1c levels saw a significant decrease of-0.32%±0.41%in the add-on group(P=0.002).However,the other groups’variables depended on the preswitch daily DPP-4i:switched from linagliptin,-0.05%±0.22%;switched from sitagliptin,-0.17%±0.33%;and switched from vildagliptin,0.45%±0.42%,which saw significant worsening(P=0.0007).Multivariate logistic regression analysis revealed that switching from vildagliptin to omarigliptin was independently associated with worsening glycemic control(P=0.0013).The mean and standard deviation of sensor glucose value,the mean amplitude of glycemic excursions,and the mean of daily difference significantly improved when switching the patient from either linagliptin or sitagliptin to omarigliptin.However,in patients switched from vildagliptin,not only did the glucose variability indices see no improvements,the mean of daily difference even underwent significant worsening.CONCLUSION Administering omarigliptin as add-on therapy or switching to it from sitagliptin and linagliptin,but not vildagliptin,improves glycemic control and thus should help in decision making when selecting DPP-4is for T2D patients.展开更多
Objective: Previous studies have shown that Tai Chi may have a role in the management of type 2 diabetes. However, to date, no studies have focused specifically on the effects of Tai Chi in people with type 1 diabetes...Objective: Previous studies have shown that Tai Chi may have a role in the management of type 2 diabetes. However, to date, no studies have focused specifically on the effects of Tai Chi in people with type 1 diabetes. The aim of this pilot study was to evaluate the effects of a Tai Chi program on health indicators in adults with type 1 diabetes. Methods: This was a two-group quasi-randomised controlled trial with 13 participants (six men and seven women, aged 24 - 63 years) with type 1 diabetes. This trial was conducted from May to November 2016. The intervention group attended Tai Chi exercise training for 1 to 1.5 hours, twice a week for 12 weeks, and the control group continued with their usual medical care. Indicators of glycaemic control (HbA1c), depressive symptoms, physical measures (body mass index, waist circumference, blood pressure and leg strength), and health-related quality of life (physical and mental components summary scores) were assessed at baseline and 12 weeks’ post-intervention. Results: There were significant or borderline significant between-group differences in changes over time in favour of the intervention group in depressive symptoms (p Conclusion: In conclusion, there were improvements in mental health and leg strength in these adults with type 1 diabetes. Large studies are needed to further investigate the effects of Tai Chi in people with Type 1 diabetes.展开更多
Cardiac autonomic neuropathy(CAN)is an often overlooked and common complication of diabetes mellitus.CAN is associated with increased cardiovascular morbidity and mortality.The pathogenesis of CAN is complex and invol...Cardiac autonomic neuropathy(CAN)is an often overlooked and common complication of diabetes mellitus.CAN is associated with increased cardiovascular morbidity and mortality.The pathogenesis of CAN is complex and involves a cascade of pathways activated by hyperglycaemia resulting in neuronal ischaemia and cellular death.In addition,autoimmune and genetic factors are involved in the development of CAN.CAN might be subclinical for several years until the patient develops resting tachycardia,exercise intolerance,postural hypotension,cardiac dysfunction and diabetic cardiomyopathy.During its sub-clinical phase,heart rate variability that is influenced by the balance between parasympathetic and sympathetic tones can help in detecting CAN before the disease is symptomatic.Newer imaging techniques(such as scintigraphy)have allowed earlier detection of CAN in the pre-clinical phase and allowed better assessment of the sympathetic nervous system.One of the main difficulties in CAN research is the lack of a universally accepted definition of CAN;however,the Toronto Consensus Panel on Diabetic Neuropathy has recently issued guidance for the diagnosis and staging of CAN,and also proposed screening for CAN in patients with diabetes mellitus.A major challenge,however,is the lack of specific treatment to slow the progression or prevent the development of CAN.Lifestyle changes,improved metabolic control might prevent or slow the progression of CAN.Reversal will require combination of these treatments with new targeted therapeutic approaches.The aim of this article is to review the latest evidence regarding the epidemiology,pathogenesis,manifestations,diagnosis and treatment for CAN.展开更多
AIM:To clarify whether nonalcoholic fatty liver disease(NAFLD)increases the risk of cardiovascular disease.METHODS:We carried out a prospective observational study with a total of 1637 apparently healthy Japanese men ...AIM:To clarify whether nonalcoholic fatty liver disease(NAFLD)increases the risk of cardiovascular disease.METHODS:We carried out a prospective observational study with a total of 1637 apparently healthy Japanese men and women who were recruited from a health check-up program.NAFLD was diagnosed by abdominal ultrasonography.The metabolic syndrome(MS)was defined according to the modified National Cholesterol Education Program(NCEP)ATP Ⅲ criteria.Five years after the baseline evaluations,the incidence of cardiovascular disease was assessed by a self-administered questionnaire.RESULTS:Among 1221 participants available for outcome analyses,the incidence of cardiovascular disease was higher in 231 subjects with NAFLD at baseline(5 coronary heart disease,6 ischemic stroke,and 1 cerebral hemorrhage)than 990 subjects without NAFLD(3 coronary heart disease,6 ischemic stroke,and 1 cerebral hemorrhage).Multivariate analyses indicated that NAFLD was a predictor of cardiovascular disease independent of conventional risk factors(odds ratio 4.12,95% CI,1.58 to 10.75,P = 0.004).MS was alsoindependently associated with cardiovascular events.But simultaneous inclusion of NAFLD and MS in a multivariate model revealed that NAFLD but not MS retained a statistically significant correlation with cardiovascular disease.CONCLUSION:Although both of them were predictors of cardiovascular disease,NAFLD but not MS retained a statistically significant correlation with cardiovascular disease in a multivariate model.NAFLD is a strong predictor of cardiovascular disease and may play a central role in the cardiovascular risk of MS.展开更多
AIM:To clarify the efficiency of the criterion of metabolic syndrome to detecting non-alcoholic fatty liver disease(NAFLD).METHODS:Authors performed a cross-sectional study involving participants of a medical health c...AIM:To clarify the efficiency of the criterion of metabolic syndrome to detecting non-alcoholic fatty liver disease(NAFLD).METHODS:Authors performed a cross-sectional study involving participants of a medical health checkup program including abdominal ultrasonography.This study involved 11 714 apparently healthy Japanese men and women,18 to 83 years of age.NAFLD was defined by abdominal ultrasonography without an alcohol intake of more than 20 g/d,known liver disease,or current use of medication.The revised criteria of the National Cholesterol Education Program Adult Treatment PanelⅢ were used to characterize the metabolic syndrome.RESULTS:NAFLD was detected in 32.2%(95%CI:31.0%-33.5%)of men(n=1874 of 5811)and in 8.7%(95%CI:8.0%-9.5%)of women(n=514 of 5903).Among obese people,the prevalence of NAFLD was as high as 67.3%(95%CI:64.8%-69.7%)in men and 45.8%(95%CI:41.7%-50.0%)in women.Although NAFLD was thought of as being the liver phenotype of metabolic syndrome,the prevalence of the metabolic syndrome among subjects with NAFLD was low both in men and women.66.8%of men and 70.4%of women with NAFLD were not diagnosed with the metabolic syndrome.48.2%of men with NAFLD and 49.8%of women with NAFLD weren't overweight[body mass index(BMI)≥25 kg/m2].In the same way,68.6%of men with NAFLD and 37.9%of women with NAFLD weren't satisfied with abdominal classification(≥90 cm for men and≥80 cm for women).Next,authors defined it as positive at screening for NAFLD when participants satisfied at least one criterion of metabolic syndrome.The sensitivity of the definition"at least 1 criterion"was as good as 84.8%in men and 86.6%in women.Separating subjects by BMI,the sensitivity was higher in obese men and women than in non-obese men and women(92.3%vs 76.8%in men,96.1%vs 77.0%in women,respectively).CONCLUSION:Authors could determine NAFLD effectively in epidemiological study by modifying the usage of the criteria for metabolic syndrome.展开更多
Thyroid hormones are critical for foetal neurological development and maternal health. Maternal hypothyroidism during pregnancy is associated with adverse impact on health of the mother as well as the progeny. Reduced...Thyroid hormones are critical for foetal neurological development and maternal health. Maternal hypothyroidism during pregnancy is associated with adverse impact on health of the mother as well as the progeny. Reduced thyroid hormone levels predispose the child to develop mental retardation and cognitive delay in early life. In the mother, hypothyroidism during pregnancy is associated with spontaneous abortion, placental abruption, preterm delivery and hypertensive disorders. Therefore, screening and therapeutic intervention is justified to prevent foetal as well as maternal co-morbidities. In view of impact of such a large-scale screening and intervention program on limited healthcare resources, it is debatable if a targeted rather than universal screening program will result in comparable outcomes. In addition, there is an ongoing debate regarding best evidence-based practice for the management of isolated hypothyroxinaemia, subclinical hypothyroidism and euthyroid women with autoimmune hypothyroidism. We have carried out a review of the literature; firstly, to determine whether universal screening for asymptomatic women in early pregnancy would be cost-effective. Secondly, we have retrospectively reviewed the literature to analyse the evidence regarding the impact of therapeutic intervention in women with subclinical hypothyroidism.展开更多
BACKGROUND Ectopic adrenocorticotropic hormone(ACTH)-secreting neuroendocrine tumors are rare diseases.Patients with ACTH-secreting pancreatic neuroendocrine carcinomas have a poor prognosis.Infections and coagulopath...BACKGROUND Ectopic adrenocorticotropic hormone(ACTH)-secreting neuroendocrine tumors are rare diseases.Patients with ACTH-secreting pancreatic neuroendocrine carcinomas have a poor prognosis.Infections and coagulopathies have been reported as the cause of death.However,detailed clinical descriptions of the morbid complications of ACTH-secreting neuroendocrine carcinomas have not been reported.CASE SUMMARY A 78-year-old Japanese woman consulted a medical center due to systemic edema and epigastric discomfort.Laboratory analysis revealed hypercortisolemia with increased ACTH secretion without diurnal variation in serum cortisol level.An enhanced computed tomography(CT)scan revealed a 3-cm tumor in the pancreatic head.The cytological material from endoscopic ultrasound-guided fine-needle aspiration was compatible with ACTHsecreting pancreatic neuroendocrine carcinoma.The Ki-67 index was 40%.She was transferred to Mie University Hospital for surgical treatment.The patient was diagnosed with urinary tract infection,cytomegalovirus hepatitis,esophageal candidiasis,pulmonary infiltrates suspicious for Pneumocystis carinii pneumonia,peripheral deep vein thrombosis,pulmonary embolism,and disseminated intravascular coagulation.The multiple organ infections and thromboses responded well to antimicrobial and anticoagulant therapy.Radioisotope studies disclosed a pancreatic tumor and a metastatic lesion in the liver,whereas somatostatin receptor scintigraphy showed negative findings,suggesting the primary and metastatic tumors were poorly differentiated.A CT scan before admission showed no metastatic liver lesion,suggesting that the pancreatic tumor was rapidly progressing.Instead of surgery,antitumor chemotherapy was indicated.The patient was transferred to another hospital to initiate chemotherapy.However,she died four months later due to the rapidly progressive tumor.CONCLUSION ACTH-secreting pancreatic neuroendocrine neoplasm is a rare disease with a very poor prognosis.The clinical course and acute complications of the tumor remain unreported.Here we report the clinical course of a rapidly progressive case of ACTH-secreting pancreatic neuroendocrine tumor that developed infectious complications due to many types of pathogens in multiple organs,widespread thromboses,pulmonary embolism,and disseminated intravascular coagulation.展开更多
Introduction: Serum Thyrotropin (TSH) level is used to assess adequacy of levothyroxine dosing for patients with hypothyroidism. Some patients have raised TSH levels despite being on an adequate dose of levothyroxine ...Introduction: Serum Thyrotropin (TSH) level is used to assess adequacy of levothyroxine dosing for patients with hypothyroidism. Some patients have raised TSH levels despite being on an adequate dose of levothyroxine (100 mcg/day - 200 mcg/day). Aim: To evaluated the effect of advising patients to take their levothyroxine 45 - 60 minutes before breakfast on raised serum TSH levels. Patients and Methods: Rather than increase the dose, patients with raised TSH levels were asked to take their levothyroxine at least 45 - 60 minutes before breakfast and other oral medications. Thyroid Function Tests were assessed at base line and repeated after two months. Results: Data from ten patients who presented between 2008 and 2010 were analyzed (9 females, 1 male): With median (IQR) age: 39 (33 - 49) years and duration of hypothyroidism: 6 (3 - 7.8) years. Median (IQR) levothyroxine dose was 175 (144 - 250) mcg, serum free-Thyroxine (free-T4): 13 (10.5 - 17.1) pmol/L and serum TSH: 12.63 (6.2 - 48.3) mIU/L. After two months all patients demonstrated biochemical improvement;a decrease in serum TSH to 3.15 (0.4 - 6.1) mIU/L accompanied by an increase in serum free-T4 to 17.7 (14.8 - 21.3) pmol/L. Both changes were statistically significant (p < 0.05 and p < 0.01, respectively). The median (IQR) percentage TSH reduction was 83.5 (40.3 - 95.8) mIU/L and this bore no significant correlation with the initial TSH level (rs = 0.2, p = 0.58). Conclusion: Changing levothyroxine administration to 45 - 60 minutes before breakfast and other oral medications reduced TSH levels by 40% - 96% in all patients. We recommend this advice for all patients with hypothyroidism on adequate doses of levothyroxine but still appear biochemically under-replaced.展开更多
Endocrine dysfunction in thalassaemia is amongst the most common complication and is principally attributed to excessive iron overload and suboptimal chelation. The prevalence is quite high particularly in multiethnic...Endocrine dysfunction in thalassaemia is amongst the most common complication and is principally attributed to excessive iron overload and suboptimal chelation. The prevalence is quite high particularly in multiethnic populations but determining the prevalence is often difficult due to the widespread heterogeneity of the population and timing of exposure to chelation therapy. Disturbances in growth, pubertal development, abnormal gonadal functions, impaired thyroid, parathyroid and adrenal functions, diabetes and disorderly bone growth are commonly encountered. Early detection and institution of appropriate transfusion regimen and chelation therapy and treatment of complications are the keys to managing this population including regular follow. In this article, we review the literature in relation to the various endocrine complications encountered in thalassaemia.展开更多
文摘Macrosomia is defined as a term birth weight greater than or equal to 4000 grams, or greater than the 90 percentile of intrauterine growth curves. Excessive weight has harmful consequences for the newborn and is a major health concern. Objectives: To determine the frequency of neonatal macrosomia, describe risk factors and neonatal and maternal complications. Materials and methods: This was a cross-sectional study carried out between January and December 2022, involving newborns whose birth weight was greater than or equal to 4000 grams admitted to the neonatology unit of the Labe regional hospital. Results: 591 deliveries were recorded, 15 of which were macrosomic, representing a frequency of 2.54%. The average age of the women was 30.26 years. History of fetal macrosomia and diabetes was 93.33 and 71.43% respectively. The mean gestational age was 38.71 ± 0.75 SA, the mean antenatal consultation was 3 ± 0.8 and the mode of delivery was caesarean section (66.67%). Third-trimester ultrasound was performed in 53.33% of cases. Macrosomic newborns were male in 80% of cases. Neonatal complications were asphyxia (60%), hypoglycemia (20%) and hypocalcemia (13.33%). Factors associated with neonatal macrosomia were diabetes (P < 0.001), history of macrosomia (P Conclusion: this study shows that the frequency of neonatal macrosomia is 2.54% with high neonatal morbidity among newborns hospitalized in the neonatology unit of the Labé regional hospital. Screening for macrosomia risk factors during pregnancy is essential to prevent perinatal complications.
文摘In recent years the treatment focus for type 2 diabetes has shifted to prevention by lifestyle change and to more aggressive reduction of blood sugars during the early stage of treatment. Weight reduction is an important goal for many people with type 2 diabetes.Bariatric surgery is no longer considered a last resort treatment. Glucagon-like peptide-1 agonists given by injection are emerging as a useful treatment since they not only lower blood sugar but are associated with a modest weight reduction. The role of the oral dipeptidyl peptidase 4 inhibitors is emerging as second line treatment ahead of sulphonylureas due to a possible beneficial effect on the beta cell and weight neutrality.Drugs which inhibit glucose re-absorption in the kidney,sodium/glucose co-transport 2 inhibitors, may have a role in the treatment of diabetes. Insulin treatment still remains the cornerstone of treatment in many patients with type 2 diabetes.
文摘AIM:To analyze the risk of coronary heart disease in patients with type 2 diabetes mellitus(T2DM)receiving standard medical treatment.METHODS:We performed a retrospective chart analysis of 269 middle-aged patients(age 45-64 years,mean age,53.9±5.5 years)with T2DM and without atherosclerotic cardiovascular events who underwent typing to determine their apolipoprotein E(apoE)isoforms.The apoE isoforms were determined using isoelectric focusing,followed by immunoblotting.We retrospectively evaluated the charts of the 269 patients,recorded between their first visit to the hospital(the study's start point,between 1987 and 1992)and the occurrence of an atherosclerotic cardiovascular event(the study's endpoint)or January 2004,whichever came first.The age-adjusted mean values and the prevalences of covariates were calculated to compare the laboratory data among the apoE phenotypes.To investigate the association of risk factors with the incidence of coronary heart disease during the follow-up period,monovariate and multivariate Cox regression models were used.RESULTS:At enrollment,the mean serum low density lipoprotein(LDL)cholesterol levels were lowest(2.92± 0.89 mmol/L)among the subjects with apoE2(apoE2/2 or apoE2/3)and highest(3.52±0.77 mmol/L)among the subjects with apoE4(apoE3/4 or apoE4/4).No significant differences in mean age or the percentage of smokers were observed among the three groups.Furthermore,no significant differences were observed in the systolic and diastolic blood pressures,body mass index,HbA1c level or serum triglyceride levels among the three groups.There were 47 cases of coronary heart disease over 3285 person-years of follow-up.An age-adjusted multivariate Cox proportional model identified diabetic retinopathy(hazard ratio,2.38,95% CI:1.28-4.43,P=0.006),a high systolic blood pressure(hazard ratio,1.04,95%CI:1.02-1.06,P<0.001) and high HbA1c values(hazard ratio,1.19,95%CI:1.02-1.38,P=0.0029),but not the LDL cholesterol value at enrollment(hazard ratio,1.01,95%CI:0.97-1.05,P=0.77)nor the specific apoE isoform,as significant predictors of coronary heart disease.CONCLUSION:Under standard medical treatment of diabetes,including the control of LDL cholesterol levels,the apoE4 isoform was not associated with coronary heart disease among T2DM patients.
文摘Both GLP-1 receptor agonists(GLP-1RA)and SGLT-2 inhibitors(SGLT-2I)are newer classes of anti-diabetic agents that lower HbA1c moderately and decrease body weight and systolic blood pressure(SBP)modestly.Combination therapy with GLP-1RA plus SGLT-2I have shown a greater reduction in HbA1c,body weight,and SBP compared to either agent alone without any significant increase in hypoglycemia or other side effects.Since several agents from each class of these drugs have shown an improvement in cardiovascular(CV)and renal outcomes in their respective cardiovascular outcome trials(CVOT),combination therapy is theoretically expected to have additional CV and renal benefits.In this comprehensive opinion review,we found HbA1c lowering with GLP-1RA plus SGLT-2I to be less than additive compared to the sum of HbA1c lowering with either agent alone,although body weight lowering was nearly additive and the SBP lowering was more than additive.Our additional meta-analysis of CV outcomes with GLP1RA plus SGLT-2I combination therapy from the pooled data of five CVOT found a similar reduction in three-point major adverse cardiovascular events compared to GLP-1RA or SGLT-2I alone,against placebo.Interestingly,a greater benefit in reduction of heart failure hospitalization with GLP-1RA plus SGLT-2I combination therapy was noted in the pooled meta-analysis of two randomized controlled trials.Future adequately powered trials can confirm whether additional CV or renal benefit is truly exerted by GLP-1RA plus SGLT-2I combination therapy.
文摘Cardiovascular disease(CVD) is the leading cause of morbidity and mortality among patients with diabetes mellitus,who have a risk of cardiovascular mortality two to four times that of people without diabetes.An individualised approach to cardiovascular risk estimation and management is needed.Over the past decades,many risk scores have been developed to predict CVD.However,few have been externally validated in a diabetic population and limited studies have examined the impact of applying a prediction model in clinical practice.Currently,guidelines are focused on testing for CVD in symptomatic patients.Atypical symptoms or silent ischemia are more common in the diabetic population,and with additional markers of vascular disease such as erectile dysfunction and autonomic neuropathy,these guidelines can be difficult to interpret.We propose an algorithm incorporating cardiovascular risk scores in combination with typical and atypical signs and symptoms to alert clinicians to consider further investigation with provocative testing.The modalities for investigation of CVD are discussed.
文摘BACKGROUND Type 2 diabetes mellitus(T2DM)is a risk factor for nonalcoholic fatty liver disease(NAFLD).AIM To determine the prevalence and clinical correlates of NAFLD in a large cohort of patients with T2DM.METHODS Four hundred thirty-seven participants with T2DM who consulted at Meijo Hospital from April 2019 to September 2020 and underwent computed tomography(CT)were assessed.The mean age was 74±13 years,and 269 were men.Hepatic attenuation minus splenic attenuation(CTL−S)less than 1 Hounsfield unit was considered fatty liver.NAFLD was defined as fatty liver in the absence of significant alcohol consumption and hepatitis virus infection.A multiple logistic regression was used to assess the independent factors associated with NAFLD.RESULTS NAFLD was identified in 25.2%of the participants.Young age(odds ratio[OR]=−0.945;95%confidence interval[CI]:0.922–0.969),higher hemoglobin levels(OR=1.501,95%CI:1.278–1.764),lower high-density lipoprotein(HDL)cholesterol levels(OR=0.971,95%CI:0.953–0.989),and the absence of dialysis(OR=0.109,95%CI:0.014–0.856)were independent predictors of NAFLD.CONCLUSION NAFLD was detected with CT in 25.2%of the participants.NAFLD was associated with younger age,higher hemoglobin levels,lower HDL cholesterol levels,and an absence of dialysis.
文摘<strong>Background:</strong> Although the frequencies of getting drug naive type 2 diabetes patients among all the diabetic patients are very low, nowadays it claims more attention in the treatment procedures of drug naive diabetic patients. But in Bangladesh, we have very few research-oriented data regarding the demographic, clinical and biochemical characteristics of drug naive type 2 diabetes patients. The aim of this study was to determine the demographic clinical and biochemical characteristics of drug naive type 2 diabetes patients of Bangladesh. <strong>Methods: </strong>This was an open label observational real-life study which was conducted in the chambers of the investigators in several places of Bangladesh as outdoor setting during the period from August 2020 to December 2020. In total, 250 patients with drug naive type 2 diabetes mellitus were enrolled as the study population. Proper written consents were taken from all the participants before starting data collection. A pre-designed questionnaire was used in patient data collection. All data were processed, analyzed and disseminated by MS Office and SPSS version as per need. <strong>Result:</strong> Two hundred and fifty (250) participants were selected as study population. The male-female ratio of the participants was 1.4:1. The highest number of participants was from 51 - 60 years’ age group (31.20%). The highest number of participants (41%) was with overweight (BMI: 25 - 30 kg/m<sup>2</sup>). Majority (65%) of the patients of this study suffered from diabetes for ≤5 years. The mean (±SD) SBP of the participants was 137.25 ± 17.50 mmHg and the mean (±SD) DBP of the participants was 85.16 ± 13.39 mmHg. We found the mean (±SD) fasting blood sugar (mg/dl), post prandial blood sugar (mg/dl), total cholesterol (mg/dl), triglycerides (mg/dl), HDL-Cholesterol (mg/dl), LDL-cholesterol (mg/dl), VLDL-cholesterol (mg/dl), uric acid (mg/dl), creatinine (mg/dl), urea (mg/dl), total bilirubin (mg/dl), direct bilirubin (mg/dl), SGOT (IU/L) and SGPT (IU/L) were 251.51 ± 112.08, 349.72 ± 128.68, 219.59 ± 68.25, 196.44 ± 94.34, 35.14 ± 11.85, 145.72 ± 64.33, 40.88 ± 18.12, 3.45 ± 1.51, 0.86 ± 0.37, 29.16 ± 9.81, 0.87 ± 0.4, 0.48 ± 0.4, 37.15 ± 10.9 and 35.83 ± 23.04 respectively. <strong>Conclusion:</strong> Obesity and hypertension demand more attention of diabetologists in diagnosis and treatment of patients or suspected patients of diabetes. Patients aged ≥ 50 years are most vulnerable and suspicious for diabetes. Besides age consequence habits of tobacco smoking, family history, smoking and HTN, alcohol intake and presence of nitrites in the urine may be considered as the most potential comorbidities for diabetic patients. Diagnosis of demographic, clinical and biochemical characteristics of drug naive type 2 diabetes patients may play a vital role in proper treatment.
基金supported by the Grants-in-Aid for Scientific Research from the Ministry of Nantong Science and Technology(No.MSZ18013).
文摘Background:During the clinical use of Jiangtangjing granules,we have found that they improve glucose metabolism and relieve symptoms in patients with type 2 diabetes mellitus.We aimed to further investigate the hypoglycemic effects of Jiangtangjing granules and the mechanisms involved.Methods:Type 2 diabetes mellitus was induced in rats by high-fat diet feeding and streptozotocin injection.The rats were then orally administered Linagliptin(3 mg/kg)or Jiangtangjing granules(13 g crude preparation/kg)for 4 weeks.The therapeutic effects of Jiangtangjing granules on glucose metabolism were then investigated.The serum glucagon-like peptide-1,insulin and glycosylated hemoglobin concentrations were measured using enzyme linked immunosorbent assay.Immunohistochemistry and quantificational real-time polymerase chain reaction were performed to quantify glucagon-like peptide-1 protein expression and cAMP,protein kinase A,and Epac1 mRNA expression,respectively.In addition,amplicon sequencing of bacterial 16s rDNA genes in rat feces was also performed to analyze the richness and diversity of the intestinal microbiota and to determine the relative abundances of the dominant bacterial phyla in the intestinal contents of the rats.Results:Jiangtangjing reduced fasting blood glucose concentration(P<0.05)and blood glucose concentrations during oral glucose tolerance testing(P<0.01),increased serum glucagon-like peptide-1 concentration after glucose administration(P<0.05)and improved glucose tolerance(P<0.05).It also increased glucagon-like peptide-1 protein expression(P<0.05)and the mRNA expression of cAMP(P<0.05),PKA(P<0.05),and Epac1(P<0.05)in the jejunum.Jiangtangjing also affected the composition of the intestinal microbiota in rats with type 2 diabetes mellitus.Specifically,it increased the relative abundance of Bacteroides and reduced that of Actinobacteria.Conclusion:Jiangtangjing granules have anti-diabetic effects,increasing circulating insulin concentration and glucose tolerance.These effects may be mediated by increases in glucagon-like peptide-1 secretion via upregulation of the cAMP/PKA signaling pathway in the jejunum and alterations in the composition of the intestinal microbiota.
文摘Diabetes mellitus is a complex condition with far reaching physical, psychological and psychosocial effects. These outcomes can be significant when considering the care of a youth transferring from paediatric through to adult diabetes services. The art of mastering a smooth care transfer is crucial if not pivotal to optimising overall diabetic control. Quite often the nature of consultation varies between the two service providers and the objectives and outcomes will mirror this. The purpose of this review is to analyse the particular challenges and barriers one might expect to encounter when transferring these services over to an adult care provider. Particular emphasis is paid towards the psychological aspects of this delicate period, which needs to be recognised and appreciated appropriately in order to understand the particular plights a young diabetic child will be challenged with. We explore the approaches that can be positively adopted in order to improve the experience for child, parents and also the multi- disciplinary team concerned with the overall delivery of this care. Finally we will close with reflection on the potential areas for future development that will ultimately aim to improve long-term outcomes and experiences of the young adolescent confronted with diabetes as well as the burden of disease and burden of cost of disease.
文摘BACKGROUND Omarigliptin is one of several once-weekly dipeptidyl peptidase-4 inhibitors(DPP-4is).Despite the high frequency of switching from various daily DPP-4is to omarigliptin in actual clinical practice,data regarding its efficacy in patients with type 2 diabetes(T2D)after switching are limited.AIM To analyze the efficacy of omarigliptin in Japanese patients with T2D who had previously received treatment with other glucose-lowering agents.METHODS Forty-nine T2D patients treated for the first time with omarigliptin were recruited retrospectively and divided into four groups defined as either add-on or switched from daily DPP-4is:switched from linagliptin,switched from sitagliptin,and switched from vildagliptin.During a 3-mo follow-up,the clinical parameters among these groups were assessed and compared,with the impact of the switch on glycemic variability as measured by continuous glucose monitoring also being evaluated in the switched groups.RESULTS Hemoglobin A1c levels saw a significant decrease of-0.32%±0.41%in the add-on group(P=0.002).However,the other groups’variables depended on the preswitch daily DPP-4i:switched from linagliptin,-0.05%±0.22%;switched from sitagliptin,-0.17%±0.33%;and switched from vildagliptin,0.45%±0.42%,which saw significant worsening(P=0.0007).Multivariate logistic regression analysis revealed that switching from vildagliptin to omarigliptin was independently associated with worsening glycemic control(P=0.0013).The mean and standard deviation of sensor glucose value,the mean amplitude of glycemic excursions,and the mean of daily difference significantly improved when switching the patient from either linagliptin or sitagliptin to omarigliptin.However,in patients switched from vildagliptin,not only did the glucose variability indices see no improvements,the mean of daily difference even underwent significant worsening.CONCLUSION Administering omarigliptin as add-on therapy or switching to it from sitagliptin and linagliptin,but not vildagliptin,improves glycemic control and thus should help in decision making when selecting DPP-4is for T2D patients.
文摘Objective: Previous studies have shown that Tai Chi may have a role in the management of type 2 diabetes. However, to date, no studies have focused specifically on the effects of Tai Chi in people with type 1 diabetes. The aim of this pilot study was to evaluate the effects of a Tai Chi program on health indicators in adults with type 1 diabetes. Methods: This was a two-group quasi-randomised controlled trial with 13 participants (six men and seven women, aged 24 - 63 years) with type 1 diabetes. This trial was conducted from May to November 2016. The intervention group attended Tai Chi exercise training for 1 to 1.5 hours, twice a week for 12 weeks, and the control group continued with their usual medical care. Indicators of glycaemic control (HbA1c), depressive symptoms, physical measures (body mass index, waist circumference, blood pressure and leg strength), and health-related quality of life (physical and mental components summary scores) were assessed at baseline and 12 weeks’ post-intervention. Results: There were significant or borderline significant between-group differences in changes over time in favour of the intervention group in depressive symptoms (p Conclusion: In conclusion, there were improvements in mental health and leg strength in these adults with type 1 diabetes. Large studies are needed to further investigate the effects of Tai Chi in people with Type 1 diabetes.
文摘Cardiac autonomic neuropathy(CAN)is an often overlooked and common complication of diabetes mellitus.CAN is associated with increased cardiovascular morbidity and mortality.The pathogenesis of CAN is complex and involves a cascade of pathways activated by hyperglycaemia resulting in neuronal ischaemia and cellular death.In addition,autoimmune and genetic factors are involved in the development of CAN.CAN might be subclinical for several years until the patient develops resting tachycardia,exercise intolerance,postural hypotension,cardiac dysfunction and diabetic cardiomyopathy.During its sub-clinical phase,heart rate variability that is influenced by the balance between parasympathetic and sympathetic tones can help in detecting CAN before the disease is symptomatic.Newer imaging techniques(such as scintigraphy)have allowed earlier detection of CAN in the pre-clinical phase and allowed better assessment of the sympathetic nervous system.One of the main difficulties in CAN research is the lack of a universally accepted definition of CAN;however,the Toronto Consensus Panel on Diabetic Neuropathy has recently issued guidance for the diagnosis and staging of CAN,and also proposed screening for CAN in patients with diabetes mellitus.A major challenge,however,is the lack of specific treatment to slow the progression or prevent the development of CAN.Lifestyle changes,improved metabolic control might prevent or slow the progression of CAN.Reversal will require combination of these treatments with new targeted therapeutic approaches.The aim of this article is to review the latest evidence regarding the epidemiology,pathogenesis,manifestations,diagnosis and treatment for CAN.
基金Supported by a grant from the Gifu Medical Association
文摘AIM:To clarify whether nonalcoholic fatty liver disease(NAFLD)increases the risk of cardiovascular disease.METHODS:We carried out a prospective observational study with a total of 1637 apparently healthy Japanese men and women who were recruited from a health check-up program.NAFLD was diagnosed by abdominal ultrasonography.The metabolic syndrome(MS)was defined according to the modified National Cholesterol Education Program(NCEP)ATP Ⅲ criteria.Five years after the baseline evaluations,the incidence of cardiovascular disease was assessed by a self-administered questionnaire.RESULTS:Among 1221 participants available for outcome analyses,the incidence of cardiovascular disease was higher in 231 subjects with NAFLD at baseline(5 coronary heart disease,6 ischemic stroke,and 1 cerebral hemorrhage)than 990 subjects without NAFLD(3 coronary heart disease,6 ischemic stroke,and 1 cerebral hemorrhage).Multivariate analyses indicated that NAFLD was a predictor of cardiovascular disease independent of conventional risk factors(odds ratio 4.12,95% CI,1.58 to 10.75,P = 0.004).MS was alsoindependently associated with cardiovascular events.But simultaneous inclusion of NAFLD and MS in a multivariate model revealed that NAFLD but not MS retained a statistically significant correlation with cardiovascular disease.CONCLUSION:Although both of them were predictors of cardiovascular disease,NAFLD but not MS retained a statistically significant correlation with cardiovascular disease in a multivariate model.NAFLD is a strong predictor of cardiovascular disease and may play a central role in the cardiovascular risk of MS.
基金Supported by Young Scientists(B)(23790791)from Japan Society for the Promotion of Science
文摘AIM:To clarify the efficiency of the criterion of metabolic syndrome to detecting non-alcoholic fatty liver disease(NAFLD).METHODS:Authors performed a cross-sectional study involving participants of a medical health checkup program including abdominal ultrasonography.This study involved 11 714 apparently healthy Japanese men and women,18 to 83 years of age.NAFLD was defined by abdominal ultrasonography without an alcohol intake of more than 20 g/d,known liver disease,or current use of medication.The revised criteria of the National Cholesterol Education Program Adult Treatment PanelⅢ were used to characterize the metabolic syndrome.RESULTS:NAFLD was detected in 32.2%(95%CI:31.0%-33.5%)of men(n=1874 of 5811)and in 8.7%(95%CI:8.0%-9.5%)of women(n=514 of 5903).Among obese people,the prevalence of NAFLD was as high as 67.3%(95%CI:64.8%-69.7%)in men and 45.8%(95%CI:41.7%-50.0%)in women.Although NAFLD was thought of as being the liver phenotype of metabolic syndrome,the prevalence of the metabolic syndrome among subjects with NAFLD was low both in men and women.66.8%of men and 70.4%of women with NAFLD were not diagnosed with the metabolic syndrome.48.2%of men with NAFLD and 49.8%of women with NAFLD weren't overweight[body mass index(BMI)≥25 kg/m2].In the same way,68.6%of men with NAFLD and 37.9%of women with NAFLD weren't satisfied with abdominal classification(≥90 cm for men and≥80 cm for women).Next,authors defined it as positive at screening for NAFLD when participants satisfied at least one criterion of metabolic syndrome.The sensitivity of the definition"at least 1 criterion"was as good as 84.8%in men and 86.6%in women.Separating subjects by BMI,the sensitivity was higher in obese men and women than in non-obese men and women(92.3%vs 76.8%in men,96.1%vs 77.0%in women,respectively).CONCLUSION:Authors could determine NAFLD effectively in epidemiological study by modifying the usage of the criteria for metabolic syndrome.
文摘Thyroid hormones are critical for foetal neurological development and maternal health. Maternal hypothyroidism during pregnancy is associated with adverse impact on health of the mother as well as the progeny. Reduced thyroid hormone levels predispose the child to develop mental retardation and cognitive delay in early life. In the mother, hypothyroidism during pregnancy is associated with spontaneous abortion, placental abruption, preterm delivery and hypertensive disorders. Therefore, screening and therapeutic intervention is justified to prevent foetal as well as maternal co-morbidities. In view of impact of such a large-scale screening and intervention program on limited healthcare resources, it is debatable if a targeted rather than universal screening program will result in comparable outcomes. In addition, there is an ongoing debate regarding best evidence-based practice for the management of isolated hypothyroxinaemia, subclinical hypothyroidism and euthyroid women with autoimmune hypothyroidism. We have carried out a review of the literature; firstly, to determine whether universal screening for asymptomatic women in early pregnancy would be cost-effective. Secondly, we have retrospectively reviewed the literature to analyse the evidence regarding the impact of therapeutic intervention in women with subclinical hypothyroidism.
文摘BACKGROUND Ectopic adrenocorticotropic hormone(ACTH)-secreting neuroendocrine tumors are rare diseases.Patients with ACTH-secreting pancreatic neuroendocrine carcinomas have a poor prognosis.Infections and coagulopathies have been reported as the cause of death.However,detailed clinical descriptions of the morbid complications of ACTH-secreting neuroendocrine carcinomas have not been reported.CASE SUMMARY A 78-year-old Japanese woman consulted a medical center due to systemic edema and epigastric discomfort.Laboratory analysis revealed hypercortisolemia with increased ACTH secretion without diurnal variation in serum cortisol level.An enhanced computed tomography(CT)scan revealed a 3-cm tumor in the pancreatic head.The cytological material from endoscopic ultrasound-guided fine-needle aspiration was compatible with ACTHsecreting pancreatic neuroendocrine carcinoma.The Ki-67 index was 40%.She was transferred to Mie University Hospital for surgical treatment.The patient was diagnosed with urinary tract infection,cytomegalovirus hepatitis,esophageal candidiasis,pulmonary infiltrates suspicious for Pneumocystis carinii pneumonia,peripheral deep vein thrombosis,pulmonary embolism,and disseminated intravascular coagulation.The multiple organ infections and thromboses responded well to antimicrobial and anticoagulant therapy.Radioisotope studies disclosed a pancreatic tumor and a metastatic lesion in the liver,whereas somatostatin receptor scintigraphy showed negative findings,suggesting the primary and metastatic tumors were poorly differentiated.A CT scan before admission showed no metastatic liver lesion,suggesting that the pancreatic tumor was rapidly progressing.Instead of surgery,antitumor chemotherapy was indicated.The patient was transferred to another hospital to initiate chemotherapy.However,she died four months later due to the rapidly progressive tumor.CONCLUSION ACTH-secreting pancreatic neuroendocrine neoplasm is a rare disease with a very poor prognosis.The clinical course and acute complications of the tumor remain unreported.Here we report the clinical course of a rapidly progressive case of ACTH-secreting pancreatic neuroendocrine tumor that developed infectious complications due to many types of pathogens in multiple organs,widespread thromboses,pulmonary embolism,and disseminated intravascular coagulation.
文摘Introduction: Serum Thyrotropin (TSH) level is used to assess adequacy of levothyroxine dosing for patients with hypothyroidism. Some patients have raised TSH levels despite being on an adequate dose of levothyroxine (100 mcg/day - 200 mcg/day). Aim: To evaluated the effect of advising patients to take their levothyroxine 45 - 60 minutes before breakfast on raised serum TSH levels. Patients and Methods: Rather than increase the dose, patients with raised TSH levels were asked to take their levothyroxine at least 45 - 60 minutes before breakfast and other oral medications. Thyroid Function Tests were assessed at base line and repeated after two months. Results: Data from ten patients who presented between 2008 and 2010 were analyzed (9 females, 1 male): With median (IQR) age: 39 (33 - 49) years and duration of hypothyroidism: 6 (3 - 7.8) years. Median (IQR) levothyroxine dose was 175 (144 - 250) mcg, serum free-Thyroxine (free-T4): 13 (10.5 - 17.1) pmol/L and serum TSH: 12.63 (6.2 - 48.3) mIU/L. After two months all patients demonstrated biochemical improvement;a decrease in serum TSH to 3.15 (0.4 - 6.1) mIU/L accompanied by an increase in serum free-T4 to 17.7 (14.8 - 21.3) pmol/L. Both changes were statistically significant (p < 0.05 and p < 0.01, respectively). The median (IQR) percentage TSH reduction was 83.5 (40.3 - 95.8) mIU/L and this bore no significant correlation with the initial TSH level (rs = 0.2, p = 0.58). Conclusion: Changing levothyroxine administration to 45 - 60 minutes before breakfast and other oral medications reduced TSH levels by 40% - 96% in all patients. We recommend this advice for all patients with hypothyroidism on adequate doses of levothyroxine but still appear biochemically under-replaced.
文摘Endocrine dysfunction in thalassaemia is amongst the most common complication and is principally attributed to excessive iron overload and suboptimal chelation. The prevalence is quite high particularly in multiethnic populations but determining the prevalence is often difficult due to the widespread heterogeneity of the population and timing of exposure to chelation therapy. Disturbances in growth, pubertal development, abnormal gonadal functions, impaired thyroid, parathyroid and adrenal functions, diabetes and disorderly bone growth are commonly encountered. Early detection and institution of appropriate transfusion regimen and chelation therapy and treatment of complications are the keys to managing this population including regular follow. In this article, we review the literature in relation to the various endocrine complications encountered in thalassaemia.
