Amir Hossein Ghanooni, Mitra KazemiJahromi, F. Hosseinpanah
Introduction: Primary aldosteronism (PA) is a clinical syndrome characterized by hypertension, suppressed plasma renin activity (PRA), elevated plasma aldosterone concentration (PAC), and spontaneous hypokalemia. Case Presentation: We present a 37-year-old normotensive female with hypokalemia, high plasma aldosterone level, and suppressed renin. The patient was treated with eplerenone and potassium chloride supplement. Further investigation with a computed tomography (CT) scan revealed a mass in the left adrenal. Laparoscopic adrenalectomy led to the diagnosis of adrenal adenoma. Conclusions: Primary aldosteronism should be among the differential diagnoses in normotensive patients presenting with severe hypokalemia.
{"title":"Primary Hyperaldosteronism in a Normotensive Patient: A Case Report","authors":"Amir Hossein Ghanooni, Mitra KazemiJahromi, F. Hosseinpanah","doi":"10.5812/ijem-138703","DOIUrl":"https://doi.org/10.5812/ijem-138703","url":null,"abstract":"Introduction: Primary aldosteronism (PA) is a clinical syndrome characterized by hypertension, suppressed plasma renin activity (PRA), elevated plasma aldosterone concentration (PAC), and spontaneous hypokalemia. Case Presentation: We present a 37-year-old normotensive female with hypokalemia, high plasma aldosterone level, and suppressed renin. The patient was treated with eplerenone and potassium chloride supplement. Further investigation with a computed tomography (CT) scan revealed a mass in the left adrenal. Laparoscopic adrenalectomy led to the diagnosis of adrenal adenoma. Conclusions: Primary aldosteronism should be among the differential diagnoses in normotensive patients presenting with severe hypokalemia.","PeriodicalId":13969,"journal":{"name":"International Journal of Endocrinology and Metabolism","volume":"9 2","pages":""},"PeriodicalIF":2.1,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139005354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Context: This review study aimed to investigate the definition, etiology, risk factors (RFs), management strategy, and prevention of insufficient weight loss (IWL) and weight regain (WR) following bariatric metabolic surgery (BMS). Evidence Acquisition: Electronic databases were searched to retrieve relevant articles. The inclusion criteria were English articles with adult participants assessing the definition, prevalence, etiology, RFs, management strategy, and prevention of IWL/WR. Results: Definition: The preferred definition for post-BMS IWL/WR are the terms "Lack of maintenance of total weight loss (TWL)>20%" and "weight change in percentage compared to nadir weight or weight loss". Prevalence: The exact prevalence of IWL/WR is still being determined due to the type of BMS and various definitions. Etiology: Several mechanisms, including hormonal/metabolic, dietary non-adherence, physical inactivity, mental health, and anatomic surgical failure, are possible etiologies of post-BMS IWL/WR. RFs: Preoperative body mass index (BMI), male gender, psychiatric conditions, comorbidities, age, poor diet, eating disorders, poor follow-ups, insufficient physical activity, micronutrients, and genetic-epigenetic factors are the most important RFs. Management Strategy: The basis of treatment is lifestyle interventions, including dietary, physical activity, psychological, and behavioral therapy. Pharmacotherapy can be added. In the last treatment line, different techniques of endoscopic surgery and revisional surgery can be used. Prevention: Behavioral and psychotherapeutic interventions, dietary therapy, and physical activity therapy are the essential components of prevention. Conclusions: Many definitions exist for WR, less so for IWL. Etiologies and RFs are complex and multifactorial; therefore, the management and prevention strategy is multidisciplinary. Some knowledge gaps, especially for IWL, exist, and these gaps must be filled to strengthen the evidence used to guide patient counseling, selection, and improved outcomes.
{"title":"What About My Weight? Insufficient Weight Loss or Weight Regain After Bariatric Metabolic Surgery","authors":"Hamidreza Zefreh, Reza Amani-Beni, Erfan Sheikhbahaei, Farnaz Farsi, Shahrzad Ahmadkaraji, Maryam Barzin, Bahar Darouei, Alireza Khalaj, Shahab Shahabi","doi":"10.5812/ijem-136329","DOIUrl":"https://doi.org/10.5812/ijem-136329","url":null,"abstract":"Context: This review study aimed to investigate the definition, etiology, risk factors (RFs), management strategy, and prevention of insufficient weight loss (IWL) and weight regain (WR) following bariatric metabolic surgery (BMS). Evidence Acquisition: Electronic databases were searched to retrieve relevant articles. The inclusion criteria were English articles with adult participants assessing the definition, prevalence, etiology, RFs, management strategy, and prevention of IWL/WR. Results: Definition: The preferred definition for post-BMS IWL/WR are the terms \"Lack of maintenance of total weight loss (TWL)>20%\" and \"weight change in percentage compared to nadir weight or weight loss\". Prevalence: The exact prevalence of IWL/WR is still being determined due to the type of BMS and various definitions. Etiology: Several mechanisms, including hormonal/metabolic, dietary non-adherence, physical inactivity, mental health, and anatomic surgical failure, are possible etiologies of post-BMS IWL/WR. RFs: Preoperative body mass index (BMI), male gender, psychiatric conditions, comorbidities, age, poor diet, eating disorders, poor follow-ups, insufficient physical activity, micronutrients, and genetic-epigenetic factors are the most important RFs. Management Strategy: The basis of treatment is lifestyle interventions, including dietary, physical activity, psychological, and behavioral therapy. Pharmacotherapy can be added. In the last treatment line, different techniques of endoscopic surgery and revisional surgery can be used. Prevention: Behavioral and psychotherapeutic interventions, dietary therapy, and physical activity therapy are the essential components of prevention. Conclusions: Many definitions exist for WR, less so for IWL. Etiologies and RFs are complex and multifactorial; therefore, the management and prevention strategy is multidisciplinary. Some knowledge gaps, especially for IWL, exist, and these gaps must be filled to strengthen the evidence used to guide patient counseling, selection, and improved outcomes.","PeriodicalId":13969,"journal":{"name":"International Journal of Endocrinology and Metabolism","volume":"73 S8","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135342622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Zahra Hosseinpour, Mostafa Rezaei-Tavirani, Mohammad Esmaeil Akbari
Background: Breast cancer (BC) is one of the most common cancers in women, significantly contributing to cancer-related death in the modern world. Obesity, as a worldwide epidemic besides the menopausal status, has a paradoxical association with BC. Objectives: To determine the molecular mechanisms underlying the paradoxical effects of obesity on BC, a comprehensive systems biology analysis was performed. Methods: Data retrieval, data preprocessing, and differential expression analysis were conducted. Weighted correlation network analysis (WGCNA) identified the gene modules associated with clinical traits. Network analysis and hub gene identification techniques revealed key regulatory genes, and functional enrichment analysis uncovered biological pathways related to hub genes. A logistic regression model was developed to predict menopausal status based on hub genes. Additionally, gene expression analysis of two important genes was performed by qPCR. Results: The study identified the hub genes and molecular pathways (the PI3K-Akt signaling pathway, proteoglycans in cancer, and lipid metabolic and atherosclerosis pathways) associated with the obesity paradox in BC based on menopausal statutes. Conclusions: These results may improve our understanding of the underlying mechanisms of the effects of body mass on BC and assist in identifying biomarkers and potential therapeutic targets for treating obese postmenopausal women with BC.
{"title":"Bioinformatic Identification of Hub Genes Related to Menopause-Obesity Paradox in Breast Cancer","authors":"Zahra Hosseinpour, Mostafa Rezaei-Tavirani, Mohammad Esmaeil Akbari","doi":"10.5812/ijem-140835","DOIUrl":"https://doi.org/10.5812/ijem-140835","url":null,"abstract":"Background: Breast cancer (BC) is one of the most common cancers in women, significantly contributing to cancer-related death in the modern world. Obesity, as a worldwide epidemic besides the menopausal status, has a paradoxical association with BC. Objectives: To determine the molecular mechanisms underlying the paradoxical effects of obesity on BC, a comprehensive systems biology analysis was performed. Methods: Data retrieval, data preprocessing, and differential expression analysis were conducted. Weighted correlation network analysis (WGCNA) identified the gene modules associated with clinical traits. Network analysis and hub gene identification techniques revealed key regulatory genes, and functional enrichment analysis uncovered biological pathways related to hub genes. A logistic regression model was developed to predict menopausal status based on hub genes. Additionally, gene expression analysis of two important genes was performed by qPCR. Results: The study identified the hub genes and molecular pathways (the PI3K-Akt signaling pathway, proteoglycans in cancer, and lipid metabolic and atherosclerosis pathways) associated with the obesity paradox in BC based on menopausal statutes. Conclusions: These results may improve our understanding of the underlying mechanisms of the effects of body mass on BC and assist in identifying biomarkers and potential therapeutic targets for treating obese postmenopausal women with BC.","PeriodicalId":13969,"journal":{"name":"International Journal of Endocrinology and Metabolism","volume":"48 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135679361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Whether the endocrine aberrations caused by polycystic ovary syndrome (PCOS) might influence bone density in women of reproductive age is controversial. Objectives: The present study aimed to compare PCOS women to a control group matched in age and body mass index (BMI) regarding bone indices and to clarify the potential relationship between their hormonal changes and bone density. Methods: This case-control study consisted of 61 PCOS patients, and 35 women with normal ovulatory function served as controls. Bone parameters, including bone mineral content (BMC) and bone mineral density (BMD) in addition to T- and Z-scores, were measured at the lumbar vertebrae, neck of the left femur, hip, and distal part of the radial bone, using dual-energy X-ray absorptiometry. Blood samples were taken to be tested for biochemical parameters and serum concentrations of insulin, osteocalcin, parathyroid hormone (PTH), vitamin D, follicle-stimulating hormone (FSH), luteinizing hormone (LH), total testosterone, dehydroepiandrosterone sulfate (DHEAS), and estradiol were measured. Insulin resistance was evaluated through the homeostatic model assessment of insulin resistance (HOMA-IR). Results: The results revealed greater levels of HOMA-IR and total testosterone in PCOS women than in controls. Nevertheless, the two groups were comparable in terms of bone parameters. In the control group, BMI was the only determinant of bone density at most of the skeletal sites. Nonetheless, BMI and HOMA-IR were independently and positively associated with bone indices at the femoral neck (FN) and total hip in the PCOS group. Parathyroid hormone and vitamin D concentrations were not different in the two groups. However, phosphate levels were higher in PCOS patients (P = 0.025). Osteocalcin was inversely correlated to BMI, and both groups had a negative correlation between DHEAS and PTH. Serum phosphate was inversely and independently associated with estrogen in the PCOS group (r = -0.377, P = 0.004). Conclusions: Body mass index and HOMA-IR were independent and positive determinants of FN and total hip bone density in the PCOS subjects. Nonetheless, in the non-PCOS women, BMI was the only independent determinant of bone density at most of the skeletal sites. Additionally, osteocalcin was inversely correlated with BMI in both groups.
背景:多囊卵巢综合征(PCOS)引起的内分泌异常是否影响育龄妇女的骨密度存在争议。目的:本研究旨在将PCOS女性与年龄和体重指数(BMI)相匹配的对照组进行比较，以阐明其激素变化与骨密度之间的潜在关系。方法:以61例PCOS患者为研究对象，35例排卵功能正常的女性为对照。采用双能x线吸收仪测量腰椎、左股骨颈、髋部和桡骨远端骨参数，包括骨矿物质含量(BMC)和骨矿物质密度(BMD)以及T和z评分。采集血样检测生化指标，测定血清胰岛素、骨钙素、甲状旁腺激素(PTH)、维生素D、卵泡刺激素(FSH)、黄体生成素(LH)、总睾酮、硫酸脱氢表雄酮(DHEAS)、雌二醇浓度。胰岛素抵抗通过胰岛素抵抗稳态模型评估(HOMA-IR)进行评估。结果:结果显示多囊卵巢综合征妇女的HOMA-IR和总睾酮水平高于对照组。然而，两组在骨骼参数方面具有可比性。在对照组中，BMI是大多数骨骼部位骨密度的唯一决定因素。尽管如此，BMI和HOMA-IR与PCOS组股骨颈(FN)和全髋关节骨指数独立且正相关。甲状旁腺激素和维生素D浓度在两组中没有差异。然而，PCOS患者的磷酸盐水平较高(P = 0.025)。骨钙素与BMI呈负相关，两组DHEAS与PTH呈负相关。PCOS组血清磷酸盐与雌激素呈负相关且独立相关(r = -0.377, P = 0.004)。结论:体重指数和HOMA-IR是PCOS患者FN和髋部总骨密度的独立和阳性决定因素。然而，在非多囊卵巢综合征女性中，BMI是大多数骨骼部位骨密度的唯一独立决定因素。此外，在两组中，骨钙素与BMI呈负相关。
{"title":"Determinants of Bone Mineral Density in Iranian Women with Polycystic Ovary Syndrome","authors":"Fariba Karimi, Parisa Mardani","doi":"10.5812/ijem-137594","DOIUrl":"https://doi.org/10.5812/ijem-137594","url":null,"abstract":"Background: Whether the endocrine aberrations caused by polycystic ovary syndrome (PCOS) might influence bone density in women of reproductive age is controversial. Objectives: The present study aimed to compare PCOS women to a control group matched in age and body mass index (BMI) regarding bone indices and to clarify the potential relationship between their hormonal changes and bone density. Methods: This case-control study consisted of 61 PCOS patients, and 35 women with normal ovulatory function served as controls. Bone parameters, including bone mineral content (BMC) and bone mineral density (BMD) in addition to T- and Z-scores, were measured at the lumbar vertebrae, neck of the left femur, hip, and distal part of the radial bone, using dual-energy X-ray absorptiometry. Blood samples were taken to be tested for biochemical parameters and serum concentrations of insulin, osteocalcin, parathyroid hormone (PTH), vitamin D, follicle-stimulating hormone (FSH), luteinizing hormone (LH), total testosterone, dehydroepiandrosterone sulfate (DHEAS), and estradiol were measured. Insulin resistance was evaluated through the homeostatic model assessment of insulin resistance (HOMA-IR). Results: The results revealed greater levels of HOMA-IR and total testosterone in PCOS women than in controls. Nevertheless, the two groups were comparable in terms of bone parameters. In the control group, BMI was the only determinant of bone density at most of the skeletal sites. Nonetheless, BMI and HOMA-IR were independently and positively associated with bone indices at the femoral neck (FN) and total hip in the PCOS group. Parathyroid hormone and vitamin D concentrations were not different in the two groups. However, phosphate levels were higher in PCOS patients (P = 0.025). Osteocalcin was inversely correlated to BMI, and both groups had a negative correlation between DHEAS and PTH. Serum phosphate was inversely and independently associated with estrogen in the PCOS group (r = -0.377, P = 0.004). Conclusions: Body mass index and HOMA-IR were independent and positive determinants of FN and total hip bone density in the PCOS subjects. Nonetheless, in the non-PCOS women, BMI was the only independent determinant of bone density at most of the skeletal sites. Additionally, osteocalcin was inversely correlated with BMI in both groups.","PeriodicalId":13969,"journal":{"name":"International Journal of Endocrinology and Metabolism","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135634944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Context: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection normally damages the respiratory system but might likewise impair endocrine organs’ function. Thyroid dysfunction and hyperglycemia are common endocrine complications of SARS-CoV-2 infection. The onset of type 1 diabetes (T1D) and associated complications, including diabetic ketoacidosis (DKA), hospitalization, and death, are thought to have increased during the coronavirus disease 2019 (COVID-19) pandemic. The aim of this study was to review the available data about the incidence rate of T1D and accompanying complications since the beginning of the COVID-19 pandemic. Evidence Acquisition: A literature review was conducted using the electronic databases PubMed and Google Scholar. The keywords “T1D, T1DM, Type 1 DM or Type 1 Diabetes”, “Coronavirus, SARS-CoV-2 or COVID-19” were used to search these databases. Titles and abstracts were screened for selection, and then relevant studies were reviewed in full text. Results: A total of 25 manuscripts out of 304 identified studies were selected. There were 15 (60%) multicenter or nationwide studies. The data about the incidence rate of T1D, hospitalization, and death are not consistent across countries; however, DKA incidence and severity seem to be higher during the COVID-19 pandemic. The present study’s data collection demonstrated that COVID-19 might or might not increase the incidence of T1D. Nevertheless, it is associated with the higher incidence and severity of DKA in T1D patients. This finding might indicate that antivirals are not fully protective against the endocrine complications of SARS-CoV-2 infection, which promotes the application of an alternative approach. Conclusions: Combining medications that reduce SARS-CoV-2 entry into the cells and modulate the immune response to infection is an alternative practical approach to treating COVID-19.
{"title":"Type 1 Diabetes and COVID-19: A Literature Review and Possible Management","authors":"Kebria Kashfi, Narges Anbardar, Artin Asadipooya, Kamyar Asadipooya","doi":"10.5812/ijem-139768","DOIUrl":"https://doi.org/10.5812/ijem-139768","url":null,"abstract":"Context: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection normally damages the respiratory system but might likewise impair endocrine organs’ function. Thyroid dysfunction and hyperglycemia are common endocrine complications of SARS-CoV-2 infection. The onset of type 1 diabetes (T1D) and associated complications, including diabetic ketoacidosis (DKA), hospitalization, and death, are thought to have increased during the coronavirus disease 2019 (COVID-19) pandemic. The aim of this study was to review the available data about the incidence rate of T1D and accompanying complications since the beginning of the COVID-19 pandemic. Evidence Acquisition: A literature review was conducted using the electronic databases PubMed and Google Scholar. The keywords “T1D, T1DM, Type 1 DM or Type 1 Diabetes”, “Coronavirus, SARS-CoV-2 or COVID-19” were used to search these databases. Titles and abstracts were screened for selection, and then relevant studies were reviewed in full text. Results: A total of 25 manuscripts out of 304 identified studies were selected. There were 15 (60%) multicenter or nationwide studies. The data about the incidence rate of T1D, hospitalization, and death are not consistent across countries; however, DKA incidence and severity seem to be higher during the COVID-19 pandemic. The present study’s data collection demonstrated that COVID-19 might or might not increase the incidence of T1D. Nevertheless, it is associated with the higher incidence and severity of DKA in T1D patients. This finding might indicate that antivirals are not fully protective against the endocrine complications of SARS-CoV-2 infection, which promotes the application of an alternative approach. Conclusions: Combining medications that reduce SARS-CoV-2 entry into the cells and modulate the immune response to infection is an alternative practical approach to treating COVID-19.","PeriodicalId":13969,"journal":{"name":"International Journal of Endocrinology and Metabolism","volume":"6 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135368677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The coronavirus disease 2019 (COVID-19) vaccine is one of the few vaccines that obtained emergency authorization to combat the fatal pandemic. Despite the fact that some available literature addressed its short-term side effects, there are still limitations on its effects on type 1 diabetes mellitus (T1DM). Objectives: The aim of the present study was to assess the association between COVID-19 vaccination and diabetic ketoacidosis (DKA) among individuals with T1DM. Additionally, the study aimed to determine the effects of the vaccine on glucose control, variability, and risk of hypoglycemia. Methods: This retrospective study was conducted at King Fahad Specialist Hospital (KFSH) in Qassim Region, Saudi Arabia. Diabetic ketoacidosis cases admitted to the hospital within February 2020 and August 2022 were included in the study based on specific inclusion criteria. Finally, a total of 49 patients were included in statistical analyses. Results: Out of the 62 patients admitted to the hospital, 49 met the diagnostic criteria for DKA and agreed to participate in the study. The majority of the remaining patients (n = 13) refused to participate, and only a few of them lacked complete documentation. Of the 49 patients who were included in the study, 46 cases had a history of T1DM; nevertheless, 3 patients were newly diagnosed with T1DM. Additionally, among these participants, 16 (32.7%), 19 (38.8%), and 14 (28.6%) patients had mild, moderate, and severe DKA, respectively. There were 27 male (55.1%) and 22 female (44.9%) patients. About 91% of the patients were vaccinated against COVID-19, 30.6% of whom were vaccinated within 29 days of being diagnosed with DKA. The pH and bicarbonate levels were observed to be significantly high among those who were diagnosed with DKA within 29 days of vaccination, with p-values of 0.031 and 0.037, respectively. Similarly, pH and random blood sugar (RBS) were observed to be significantly higher among the vaccinated patients than in the non-vaccinated subjects (P = 0.044 and P = 0.032, respectively). Conclusions: The study findings revealed that some of the DKA indicators were evident among the vaccinated patients. However, larger-scale and multi-center studies are recommended in order to have more conclusive evidence and generalize the findings.
{"title":"Diabetic Ketoacidosis After COVID-19 Vaccine in Patients with Type 1 Diabetes Mellitus","authors":"Fahad Bedaiwi Albedaiwi, Manar Alshammari, Metab Algeffari, Abdulmajeed Alfouzan, Yasmeen Alfouzan, Hassan Siddiq, Omaima Hussein","doi":"10.5812/ijem-135866","DOIUrl":"https://doi.org/10.5812/ijem-135866","url":null,"abstract":"Background: The coronavirus disease 2019 (COVID-19) vaccine is one of the few vaccines that obtained emergency authorization to combat the fatal pandemic. Despite the fact that some available literature addressed its short-term side effects, there are still limitations on its effects on type 1 diabetes mellitus (T1DM). Objectives: The aim of the present study was to assess the association between COVID-19 vaccination and diabetic ketoacidosis (DKA) among individuals with T1DM. Additionally, the study aimed to determine the effects of the vaccine on glucose control, variability, and risk of hypoglycemia. Methods: This retrospective study was conducted at King Fahad Specialist Hospital (KFSH) in Qassim Region, Saudi Arabia. Diabetic ketoacidosis cases admitted to the hospital within February 2020 and August 2022 were included in the study based on specific inclusion criteria. Finally, a total of 49 patients were included in statistical analyses. Results: Out of the 62 patients admitted to the hospital, 49 met the diagnostic criteria for DKA and agreed to participate in the study. The majority of the remaining patients (n = 13) refused to participate, and only a few of them lacked complete documentation. Of the 49 patients who were included in the study, 46 cases had a history of T1DM; nevertheless, 3 patients were newly diagnosed with T1DM. Additionally, among these participants, 16 (32.7%), 19 (38.8%), and 14 (28.6%) patients had mild, moderate, and severe DKA, respectively. There were 27 male (55.1%) and 22 female (44.9%) patients. About 91% of the patients were vaccinated against COVID-19, 30.6% of whom were vaccinated within 29 days of being diagnosed with DKA. The pH and bicarbonate levels were observed to be significantly high among those who were diagnosed with DKA within 29 days of vaccination, with p-values of 0.031 and 0.037, respectively. Similarly, pH and random blood sugar (RBS) were observed to be significantly higher among the vaccinated patients than in the non-vaccinated subjects (P = 0.044 and P = 0.032, respectively). Conclusions: The study findings revealed that some of the DKA indicators were evident among the vaccinated patients. However, larger-scale and multi-center studies are recommended in order to have more conclusive evidence and generalize the findings.","PeriodicalId":13969,"journal":{"name":"International Journal of Endocrinology and Metabolism","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135197510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-29eCollection Date: 2023-07-01DOI: 10.5812/ijem-136900
Daisy Carolina Buenaventura, Hernando Vargas-Sierra, Natalia Aristizabal-Henao, Jose Luis Torres-Grajales, Carolina Aguilar-Londono, Johnayro Gutierrez-Restrepo
Posterior reversible encephalopathy syndrome (PRES) is an uncommon transient neuroradiological phenomenon that develops vasogenic cerebral edema and could be caused by some pharmacological agents, such as molecular-specific target agents. Lenvatinib belongs to the tyrosine kinase inhibitors and was approved in 2015 for progressive locally advanced or metastatic thyroid cancer refractory to radioactive iodine (I-131) treatment. Herein, we present the case of a 65-year-old woman who, while receiving treatment with lenvatinib for radioiodine-refractory metastatic papillary thyroid carcinoma, developed PRES without hypertension at the initial evaluation. Her clinical and radiological findings improved after withdrawing from the mentioned therapy, and later it was possible to re-incorporate lower doses of the medication, as described in the other three case reports found in the worldwide medical literature. The recognition of this entity is essential to timely suspend the drug and avoid greater comorbidity. This is the first paper reporting this kind of adverse event using lenvatinib in a Hispanic population.
{"title":"Posterior Reversible Encephalopathy Syndrome as an Adverse Effect of Lenvatinib in a Patient with Papillary Thyroid Carcinoma: A Case Report.","authors":"Daisy Carolina Buenaventura, Hernando Vargas-Sierra, Natalia Aristizabal-Henao, Jose Luis Torres-Grajales, Carolina Aguilar-Londono, Johnayro Gutierrez-Restrepo","doi":"10.5812/ijem-136900","DOIUrl":"10.5812/ijem-136900","url":null,"abstract":"<p><p>Posterior reversible encephalopathy syndrome (PRES) is an uncommon transient neuroradiological phenomenon that develops vasogenic cerebral edema and could be caused by some pharmacological agents, such as molecular-specific target agents. Lenvatinib belongs to the tyrosine kinase inhibitors and was approved in 2015 for progressive locally advanced or metastatic thyroid cancer refractory to radioactive iodine (I-131) treatment. Herein, we present the case of a 65-year-old woman who, while receiving treatment with lenvatinib for radioiodine-refractory metastatic papillary thyroid carcinoma, developed PRES without hypertension at the initial evaluation. Her clinical and radiological findings improved after withdrawing from the mentioned therapy, and later it was possible to re-incorporate lower doses of the medication, as described in the other three case reports found in the worldwide medical literature. The recognition of this entity is essential to timely suspend the drug and avoid greater comorbidity. This is the first paper reporting this kind of adverse event using lenvatinib in a Hispanic population.</p>","PeriodicalId":13969,"journal":{"name":"International Journal of Endocrinology and Metabolism","volume":"1 1","pages":"e136900"},"PeriodicalIF":2.1,"publicationDate":"2023-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10676670/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71265597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background Coronavirus disease 2019 (COVID-19) has spread quickly. Comorbidities, such as diabetes, have been determined as critical risk factors for COVID-19. Objectives This study aimed to determine the frequency and severity of diabetic ketoacidosis (DKA) in children before and during the COVID-19 pandemic. Methods This retrospective study examined children aged less than 18 years diagnosed with DKA hospitalized in Yazd Shahid Sadoughi Hospital from February 20, 2020, to November 21, 2021. The collected information was compared to those obtained during the same period in 2019 (pre-pandemic). According to the inclusion criteria, only children with suspected symptoms of COVID-19 or an infected family member underwent PCR. Results The study included 70 children with confirmed DKA during the COVID-19 pandemic and 33 children hospitalized during the pre-pandemic period. The findings showed that the rate of DKA was higher during the pandemic than in the pre-pandemic period. In the DKA subgroups (during the COVID-19 pandemic vs. pre-pandemic), 35.7% vs. 21.2% were severe, 37.1% vs. 36.4% were moderate, and 27.1% vs. 42.4% were mild. Of 70 children, 30 underwent PCR tests for COVID-19, showing six positive cases. Among positive cases, five had mild symptoms, while one was hospitalized with signs of respiratory distress, polyuria, and polydipsia. All physical examinations of this patient were normal, except for the chest exam. Conclusions A remarkable increase was observed in the frequency and severity of DKA in children during the pandemic.
{"title":"Diabetic Ketoacidosis in Children Before and During COVID-19 Pandemic: A Cross-sectional Study.","authors":"Mahtab Ordooei, Mehran Karimi, Elahe Akbarian, Zahra Rasoulizadeh","doi":"10.5812/ijem-132809","DOIUrl":"10.5812/ijem-132809","url":null,"abstract":"Background Coronavirus disease 2019 (COVID-19) has spread quickly. Comorbidities, such as diabetes, have been determined as critical risk factors for COVID-19. Objectives This study aimed to determine the frequency and severity of diabetic ketoacidosis (DKA) in children before and during the COVID-19 pandemic. Methods This retrospective study examined children aged less than 18 years diagnosed with DKA hospitalized in Yazd Shahid Sadoughi Hospital from February 20, 2020, to November 21, 2021. The collected information was compared to those obtained during the same period in 2019 (pre-pandemic). According to the inclusion criteria, only children with suspected symptoms of COVID-19 or an infected family member underwent PCR. Results The study included 70 children with confirmed DKA during the COVID-19 pandemic and 33 children hospitalized during the pre-pandemic period. The findings showed that the rate of DKA was higher during the pandemic than in the pre-pandemic period. In the DKA subgroups (during the COVID-19 pandemic vs. pre-pandemic), 35.7% vs. 21.2% were severe, 37.1% vs. 36.4% were moderate, and 27.1% vs. 42.4% were mild. Of 70 children, 30 underwent PCR tests for COVID-19, showing six positive cases. Among positive cases, five had mild symptoms, while one was hospitalized with signs of respiratory distress, polyuria, and polydipsia. All physical examinations of this patient were normal, except for the chest exam. Conclusions A remarkable increase was observed in the frequency and severity of DKA in children during the pandemic.","PeriodicalId":13969,"journal":{"name":"International Journal of Endocrinology and Metabolism","volume":"21 2","pages":"e132809"},"PeriodicalIF":2.1,"publicationDate":"2023-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c3/8b/ijem-21-2-132809.PMC10474797.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10524568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Diabetes Ketoacidosis and COVID-19: An Insight into the Pathophysiology.","authors":"Seyed Amirabbas Ahadiat, Zeinab Hosseinian","doi":"10.5812/ijem-133631","DOIUrl":"https://doi.org/10.5812/ijem-133631","url":null,"abstract":"<jats:p />","PeriodicalId":13969,"journal":{"name":"International Journal of Endocrinology and Metabolism","volume":"21 2","pages":"e133631"},"PeriodicalIF":2.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e1/8d/ijem-21-2-133631.PMC10467579.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10659944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Context: The coronavirus disease 2019 (COVID-19) pandemic is still a cause of worldwide health concern. Diabetes and its associated comorbidities are risk factors for mortality and morbidity in COVID-19. Selecting the right antidiabetic drug to achieve optimal glycemic control might mitigate some of the negative impacts of diabetes. Metformin continues to be the most widely administered antidiabetic agent. There is evidence of its beneficial outcome in COVID-19 independent of its glucose-lowering effect.
Evidence acquisition: A thorough literature search was conducted in PubMed, Google Scholar, Scopus, and Web of Science to identify studies investigating metformin in COVID-19.
Results: Several overlapping mechanisms have been proposed to explain its antiviral properties. It could bring about conformational changes in the angiotensin-converting enzyme-2 receptor and decrease viral entry. The effects on the mammalian target of the rapamycin pathway and cellular pH have been proposed to reduce viral protein synthesis and replication. The immunomodulatory effects of metformin might counter the detrimental effects of hyperinflammation associated with COVID-19.
Conclusions: These findings call for broader metformin usage to manage hyperglycemia in COVID-19.
背景:2019冠状病毒病(COVID-19)大流行仍然是全球健康关注的一个原因。糖尿病及其相关合并症是COVID-19患者死亡和发病的危险因素。选择正确的降糖药来达到最佳的血糖控制可能会减轻糖尿病的一些负面影响。二甲双胍仍然是最广泛使用的降糖药。有证据表明其在COVID-19中的有益结果独立于其降血糖作用。证据获取:在PubMed、Google Scholar、Scopus和Web of Science中进行了全面的文献检索，以确定调查二甲双胍在COVID-19中的作用的研究。结果:提出了几种重叠机制来解释其抗病毒特性。它可以引起血管紧张素转换酶-2受体的构象改变，减少病毒的进入。雷帕霉素途径对哺乳动物靶点和细胞pH的影响已被提出，以减少病毒蛋白的合成和复制。二甲双胍的免疫调节作用可能会抵消与COVID-19相关的过度炎症的有害影响。结论:这些发现呼吁更广泛地使用二甲双胍来控制COVID-19患者的高血糖。
{"title":"Metformin in COVID-19: Is There a Role Beyond Glycemic Control?","authors":"Lakshmi Nagendra, Saptarshi Bhattacharya, Sanjay Kalra, Nitin Kapoor","doi":"10.5812/ijem-132965","DOIUrl":"https://doi.org/10.5812/ijem-132965","url":null,"abstract":"<p><strong>Context: </strong>The coronavirus disease 2019 (COVID-19) pandemic is still a cause of worldwide health concern. Diabetes and its associated comorbidities are risk factors for mortality and morbidity in COVID-19. Selecting the right antidiabetic drug to achieve optimal glycemic control might mitigate some of the negative impacts of diabetes. Metformin continues to be the most widely administered antidiabetic agent. There is evidence of its beneficial outcome in COVID-19 independent of its glucose-lowering effect.</p><p><strong>Evidence acquisition: </strong>A thorough literature search was conducted in PubMed, Google Scholar, Scopus, and Web of Science to identify studies investigating metformin in COVID-19.</p><p><strong>Results: </strong>Several overlapping mechanisms have been proposed to explain its antiviral properties. It could bring about conformational changes in the angiotensin-converting enzyme-2 receptor and decrease viral entry. The effects on the mammalian target of the rapamycin pathway and cellular pH have been proposed to reduce viral protein synthesis and replication. The immunomodulatory effects of metformin might counter the detrimental effects of hyperinflammation associated with COVID-19.</p><p><strong>Conclusions: </strong>These findings call for broader metformin usage to manage hyperglycemia in COVID-19.</p>","PeriodicalId":13969,"journal":{"name":"International Journal of Endocrinology and Metabolism","volume":"21 2","pages":"e132965"},"PeriodicalIF":2.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d6/a7/ijem-21-2-132965.PMC10467582.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10127539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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