M. Aboelnaga, E. Aboelnaga, S. Abdelkhalek, M. El Shaer, Nahed Abdallah
Background: We aimed to evaluate the effect of visceral obesity and vitamin D status on colon cancer and to investigate the possible link between visceral obesity and vitamin D in those patients. Methods: This case-control study included 60 colon cancer patients and 40 subjects as control. Clinical, anthropometric, and pathological data were collected. Calculation of visceral adiposity index (VAI) and detection of vitamin D (25(OH)D) levels were performed and compared between groups. Results: There were significant differences in VAI and level of 25(OH)D between both groups. Moreover, we found a significantly higher prevalence of vitamin D deficiency in the patient’ group (53.3%) versus the control group (32.5%). There was a significant different mean of VAI in vitamin D deficient patients versus non-deficient patients (P = 0.024). We found a significantly different means of VAI and vitamin D in the patients’ group with different TNM stages, as higher stages are associated with a lower level of vitamin D and higher VAI. Conclusions: VAI and 25(OH)D were different in colon cancer patients compared with control. Likewise, they had different means with different TNM stages. Vitamin D may augment the inflammatory status in visceral obesity which is involved in tumorigenesis of colon cancer. J Endocrinol Metab. 2021;11(5):115-122 doi: https://doi.org/10.14740/jem762
{"title":"Evaluation of Visceral Adiposity Index and Vitamin D Status in Colon Cancer: Is Visceral Obesity the Missing Link?","authors":"M. Aboelnaga, E. Aboelnaga, S. Abdelkhalek, M. El Shaer, Nahed Abdallah","doi":"10.14740/jem762","DOIUrl":"https://doi.org/10.14740/jem762","url":null,"abstract":"Background: We aimed to evaluate the effect of visceral obesity and vitamin D status on colon cancer and to investigate the possible link between visceral obesity and vitamin D in those patients. Methods: This case-control study included 60 colon cancer patients and 40 subjects as control. Clinical, anthropometric, and pathological data were collected. Calculation of visceral adiposity index (VAI) and detection of vitamin D (25(OH)D) levels were performed and compared between groups. Results: There were significant differences in VAI and level of 25(OH)D between both groups. Moreover, we found a significantly higher prevalence of vitamin D deficiency in the patient’ group (53.3%) versus the control group (32.5%). There was a significant different mean of VAI in vitamin D deficient patients versus non-deficient patients (P = 0.024). We found a significantly different means of VAI and vitamin D in the patients’ group with different TNM stages, as higher stages are associated with a lower level of vitamin D and higher VAI. Conclusions: VAI and 25(OH)D were different in colon cancer patients compared with control. Likewise, they had different means with different TNM stages. Vitamin D may augment the inflammatory status in visceral obesity which is involved in tumorigenesis of colon cancer. J Endocrinol Metab. 2021;11(5):115-122 doi: https://doi.org/10.14740/jem762","PeriodicalId":15712,"journal":{"name":"Journal of Endocrinology and Metabolism","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48144519","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: Obesity can seriously damage human health and have the potential to raise the likelihood of diabetes mellitus (DM) and other adverse outcomes. Successful therapeutic options and medications have been designed to reduce weight. Glucagon-like peptide-1 receptor agonists (GLP-1Ras) are recommended to reduce the weight among obese patients either with or without type 2 DM (T2DM). We intended to perform the systematic review to synthesize the findings from the studies that have explored the efficacy of GLP-1Ras in reducing weight among obese individuals. Methods: A wide range of electronic bibliographic databases such as PubMed, Embase, and ERIC was searched. Based on the eligibility criteria, both observational and non-observational (experimental) studies that assessed the efficacy of GLP-1Ras in reducing weight loss among obese individuals from January 2010 to July 2021 were incorporated in the review. Following screening and assessing the abstracts, we ended up reviewing 20 full-text articles, and data were extracted on important parameters such as country, sample size, type of non-surgical treatment, time of follow-up, and primary outcomes. Results: Overall, the findings of the systematic review appear promising for the efficacy of different GLP-1Ras in reducing the weight and related parameters of obesity such as body mass index and lean body mass. More precisely, individuals lost weight of about minimum of 5.1 kg and maximum of 6.16 kg in the intervention group or those who were observed to use any type of GLP-1Ras as opposed to 1.6 - 3.97 kg lost among those individuals who did not use any type of GLP-1Ras. These results with their respective effect sizes were statistically significant with a P-value of < 0.05. A wide variety of GLP-1Ras such as liraglutide, exenatide, semaglutide, and dulaglutide are considered safe to reduce weight loss among individuals aged 18 - 65 years. Out of 13 studies included in this review, 12 showed statistically significant results with a P-value of less than 0.05 in all the included studies. Conclusion: Given their likely advantages further than glycemic control in reducing the weight, GLP-1 agonists may help to treat the obesity either among diabetic or non-diabetic individuals soon. Though, further research studies mainly large clinical trials are required to broaden and completely explain the favorable effects and potential side effects of GLP-1 agonists. J Endocrinol Metab. 2021;11(5):95-107 doi: https://doi.org/10.14740/jem745
{"title":"Efficacy of Glucagon-Like Peptide-1 Receptor Agonists in the Weight Loss Among Obese Individuals: A Systematic Review","authors":"Raed Aldahash","doi":"10.14740/jem745","DOIUrl":"https://doi.org/10.14740/jem745","url":null,"abstract":"Background: Obesity can seriously damage human health and have the potential to raise the likelihood of diabetes mellitus (DM) and other adverse outcomes. Successful therapeutic options and medications have been designed to reduce weight. Glucagon-like peptide-1 receptor agonists (GLP-1Ras) are recommended to reduce the weight among obese patients either with or without type 2 DM (T2DM). We intended to perform the systematic review to synthesize the findings from the studies that have explored the efficacy of GLP-1Ras in reducing weight among obese individuals. Methods: A wide range of electronic bibliographic databases such as PubMed, Embase, and ERIC was searched. Based on the eligibility criteria, both observational and non-observational (experimental) studies that assessed the efficacy of GLP-1Ras in reducing weight loss among obese individuals from January 2010 to July 2021 were incorporated in the review. Following screening and assessing the abstracts, we ended up reviewing 20 full-text articles, and data were extracted on important parameters such as country, sample size, type of non-surgical treatment, time of follow-up, and primary outcomes. Results: Overall, the findings of the systematic review appear promising for the efficacy of different GLP-1Ras in reducing the weight and related parameters of obesity such as body mass index and lean body mass. More precisely, individuals lost weight of about minimum of 5.1 kg and maximum of 6.16 kg in the intervention group or those who were observed to use any type of GLP-1Ras as opposed to 1.6 - 3.97 kg lost among those individuals who did not use any type of GLP-1Ras. These results with their respective effect sizes were statistically significant with a P-value of < 0.05. A wide variety of GLP-1Ras such as liraglutide, exenatide, semaglutide, and dulaglutide are considered safe to reduce weight loss among individuals aged 18 - 65 years. Out of 13 studies included in this review, 12 showed statistically significant results with a P-value of less than 0.05 in all the included studies. Conclusion: Given their likely advantages further than glycemic control in reducing the weight, GLP-1 agonists may help to treat the obesity either among diabetic or non-diabetic individuals soon. Though, further research studies mainly large clinical trials are required to broaden and completely explain the favorable effects and potential side effects of GLP-1 agonists. J Endocrinol Metab. 2021;11(5):95-107 doi: https://doi.org/10.14740/jem745","PeriodicalId":15712,"journal":{"name":"Journal of Endocrinology and Metabolism","volume":"1 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41391284","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}
Christoffer Krogager, Anne Margareta Banghøj, P. L. Poulsen, Martin G. Kirkegaard, B. Thorsteinsson, L. Tarnow, E. Laugesen, K. Hansen
Background: The aim of this study is to evaluate the effects of 12-month continuous positive airway pressure (CPAP) treatment on arterial stiffness in patients with type 2 diabetes. Methods: Obstructive sleep apnea (OSA) and type 2 diabetes frequently co-exists. Both diseases increase arterial stiffness, a marker of cardiovascular risk. Treating OSA with CPAP may lower arterial stiffness. In a recent randomized trial, we found that CPAP treatment for 12 weeks did not reduce arterial stiffness in type 2 diabetes patients with OSA. Participants from the randomized trial were invited to a follow-up study 12 months after inclusion. We evaluated arterial stiffness by measuring carotid-femoral pulse wave velocity (cfPWV) using SphygmoCor. Results: Forty-six patients (63.9% of the original 72 patients, age 63.8 ± 6.5 years, diabetes duration 16.1 ± 9.7 years, body mass index (BMI) 34.7 ± 3.9 kg/m 2 ) partook in the study. Mean duration of CPAP treatment was 10.5 ± 1.5 months. Baseline cfPWV was 10.7 m/s. At follow-up cfPWV was 10.6 m/s, change in cfPWV: -0.12 m/s, 95% confidence interval (CI): -0.6, 0.4, P = 0.6. Baseline systolic blood pressure (BP) was 136.2 mm Hg. At follow-up BP was 137.9 mm Hg, change in BP: 1.6 mm Hg, 95% CI: -2.3, 5.5. Conclusions: We found no effect of 9 - 12-month CPAP treatment on arterial stiffness or BP in patients with long duration of type 2 diabetes and OSA. J Endocrinol Metab. 2021;11(5):134-139 doi: https://doi.org/10.14740/jem773
{"title":"Continuous Positive Airway Pressure Treatment for Obstructive Sleep Apnea Does Not Reduce Arterial Stiffness in Patients With Type 2 Diabetes After One Year of Follow-Up","authors":"Christoffer Krogager, Anne Margareta Banghøj, P. L. Poulsen, Martin G. Kirkegaard, B. Thorsteinsson, L. Tarnow, E. Laugesen, K. Hansen","doi":"10.14740/jem773","DOIUrl":"https://doi.org/10.14740/jem773","url":null,"abstract":"Background: The aim of this study is to evaluate the effects of 12-month continuous positive airway pressure (CPAP) treatment on arterial stiffness in patients with type 2 diabetes. Methods: Obstructive sleep apnea (OSA) and type 2 diabetes frequently co-exists. Both diseases increase arterial stiffness, a marker of cardiovascular risk. Treating OSA with CPAP may lower arterial stiffness. In a recent randomized trial, we found that CPAP treatment for 12 weeks did not reduce arterial stiffness in type 2 diabetes patients with OSA. Participants from the randomized trial were invited to a follow-up study 12 months after inclusion. We evaluated arterial stiffness by measuring carotid-femoral pulse wave velocity (cfPWV) using SphygmoCor. Results: Forty-six patients (63.9% of the original 72 patients, age 63.8 ± 6.5 years, diabetes duration 16.1 ± 9.7 years, body mass index (BMI) 34.7 ± 3.9 kg/m 2 ) partook in the study. Mean duration of CPAP treatment was 10.5 ± 1.5 months. Baseline cfPWV was 10.7 m/s. At follow-up cfPWV was 10.6 m/s, change in cfPWV: -0.12 m/s, 95% confidence interval (CI): -0.6, 0.4, P = 0.6. Baseline systolic blood pressure (BP) was 136.2 mm Hg. At follow-up BP was 137.9 mm Hg, change in BP: 1.6 mm Hg, 95% CI: -2.3, 5.5. Conclusions: We found no effect of 9 - 12-month CPAP treatment on arterial stiffness or BP in patients with long duration of type 2 diabetes and OSA. J Endocrinol Metab. 2021;11(5):134-139 doi: https://doi.org/10.14740/jem773","PeriodicalId":15712,"journal":{"name":"Journal of Endocrinology and Metabolism","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42112742","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}
D. Mohamed, W. Elayat, A. Abozeid, M. Abdel-Salam, N. Teama, Dina S Abdelrahim, Yomna M. Tamim
Background: Type 2 diabetes mellitus (DM) has many complications associated with increased morbidity and mortality. Cardiovascular complications are one of these serious complications. Therefore, there is a need for early and effective management to hamper them. This study aimed to evaluate the cardioprotective efficacy of metformin and myoinositol combination through exploring the associated underlying mechanisms in type 2 DM rat model. Methods: Type 2 DM model was induced in rats by streptozotocin and high-fat diet. Rats were treated with metformin (150 mg/kg) and/or myoinositol (50 mg/kg) by oral gavage once daily for 4 weeks. Immunohistochemistry was used to assess the drugs’ cardioprotective efficacy by estimating troponin T, nuclear factor kappa B (NF-kappaB) and tumor necrosis factor alpha (TNF-alpha). Quantitative real-time polymerase chain reaction and enzyme-linked immunosorbent assay were utilized to investigate peroxisome proliferator-activated receptor-alpha (PPARalpha) and glucose transporter 4 (GLUT-4) expression levels in the skeletal muscles, respectively. Results: This study found that metformin and myoinositol combination was associated with GLUT-4 and PPARalpha overexpression, together with better lipid profile than metformin alone in diabetic rats. Additionally, the combination of both drugs improved troponin C and decreased creatine kinase MB isoenzyme, NF-kappaB and TNF-alpha cardiac levels. Conclusion: The current study indicated that myoinositol in combination with metformin had better cardioprotective effect than metformin alone in type 2 DM. This favorable effect was exhibited through upregulation of GLUT-4 and PPARalpha receptors expression in skeletal muscles, thus increasing insulin sensitivity and improving lipid profile. J Endocrinol Metab. 2021;11(5):140-151 doi: https://doi.org/10.14740/jem765
{"title":"Glucose Transporter 4 and Peroxisome Proliferator-Activated Receptor-Alpha Overexpression Association With Cardioprotective Effects of Myoinositol and Metformin Combination in Type 2 Diabetic Rat Model","authors":"D. Mohamed, W. Elayat, A. Abozeid, M. Abdel-Salam, N. Teama, Dina S Abdelrahim, Yomna M. Tamim","doi":"10.14740/jem765","DOIUrl":"https://doi.org/10.14740/jem765","url":null,"abstract":"Background: Type 2 diabetes mellitus (DM) has many complications associated with increased morbidity and mortality. Cardiovascular complications are one of these serious complications. Therefore, there is a need for early and effective management to hamper them. This study aimed to evaluate the cardioprotective efficacy of metformin and myoinositol combination through exploring the associated underlying mechanisms in type 2 DM rat model. Methods: Type 2 DM model was induced in rats by streptozotocin and high-fat diet. Rats were treated with metformin (150 mg/kg) and/or myoinositol (50 mg/kg) by oral gavage once daily for 4 weeks. Immunohistochemistry was used to assess the drugs’ cardioprotective efficacy by estimating troponin T, nuclear factor kappa B (NF-kappaB) and tumor necrosis factor alpha (TNF-alpha). Quantitative real-time polymerase chain reaction and enzyme-linked immunosorbent assay were utilized to investigate peroxisome proliferator-activated receptor-alpha (PPARalpha) and glucose transporter 4 (GLUT-4) expression levels in the skeletal muscles, respectively. Results: This study found that metformin and myoinositol combination was associated with GLUT-4 and PPARalpha overexpression, together with better lipid profile than metformin alone in diabetic rats. Additionally, the combination of both drugs improved troponin C and decreased creatine kinase MB isoenzyme, NF-kappaB and TNF-alpha cardiac levels. Conclusion: The current study indicated that myoinositol in combination with metformin had better cardioprotective effect than metformin alone in type 2 DM. This favorable effect was exhibited through upregulation of GLUT-4 and PPARalpha receptors expression in skeletal muscles, thus increasing insulin sensitivity and improving lipid profile. J Endocrinol Metab. 2021;11(5):140-151 doi: https://doi.org/10.14740/jem765","PeriodicalId":15712,"journal":{"name":"Journal of Endocrinology and Metabolism","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47226652","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}
Regitze Wittenberg, T. R. Larsen, L. Stilgren, S. Antonsen
Background: Ionized calcium (pH = 7.4) (CaI) is a laborious test compared to tests for total calcium (CaT). However, CaI is the biologically active part of calcium in the blood and is therefore often considered the most relevant measure of calcium status. In this study, CaI and CaT tests were compared by identifying clinically relevant hypercalcemia (HC) in unselected patients acutely admitted to an emergency department (ED). Methods: CaI and CaT were measured in all medical patients admitted to the ED at a single Danish Hospital (N = 13,400) between January 2018 and May 2019. The majority (97%) of the patients were admitted 1 - 3 times summing up to a total of 17,838 admissions. As limits for clinically relevant HC, 1.45 mmol/L for CaI and 2.77 mmol/L for CaT were used. Mismatches were defined as one test being equal to or above the limit while the other test was within or below its reference interval. In cases of mismatch, the medical record was reviewed. Results: Seventeen mismatches with CaI ? 1.45 mmol/L were observed in 16 patients, of whom eight were known with diseases with risk of HC. Five patients had HC with no clinical relevance, one had HC of unknown relevance, and only two patients were discovered as having a prior unknown calcium metabolic disease. Three mismatches were observed in admissions with CaT ? 2.77 mmol/L. Mismatches did in none of these cases have any clinical consequences. Conclusion: By using CaT as a screening method for HC instead of CaI, only two patients with prior unrecognized HC would have been missed and it did not result in a large number of patients with false HC. We therefore find that CaT is an acceptable test when screening for HC in the ED. J Endocrinol Metab. 2021;11(5):108-114 doi: https://doi.org/10.14740/jem757
{"title":"Total Calcium and Ionized Calcium (pH = 7.4) Tests Are Equal When Screening Patients for Hypercalcemia at Admission in the Emergency Department: A Retrospective Descriptive Study","authors":"Regitze Wittenberg, T. R. Larsen, L. Stilgren, S. Antonsen","doi":"10.14740/jem757","DOIUrl":"https://doi.org/10.14740/jem757","url":null,"abstract":"Background: Ionized calcium (pH = 7.4) (CaI) is a laborious test compared to tests for total calcium (CaT). However, CaI is the biologically active part of calcium in the blood and is therefore often considered the most relevant measure of calcium status. In this study, CaI and CaT tests were compared by identifying clinically relevant hypercalcemia (HC) in unselected patients acutely admitted to an emergency department (ED). Methods: CaI and CaT were measured in all medical patients admitted to the ED at a single Danish Hospital (N = 13,400) between January 2018 and May 2019. The majority (97%) of the patients were admitted 1 - 3 times summing up to a total of 17,838 admissions. As limits for clinically relevant HC, 1.45 mmol/L for CaI and 2.77 mmol/L for CaT were used. Mismatches were defined as one test being equal to or above the limit while the other test was within or below its reference interval. In cases of mismatch, the medical record was reviewed. Results: Seventeen mismatches with CaI ? 1.45 mmol/L were observed in 16 patients, of whom eight were known with diseases with risk of HC. Five patients had HC with no clinical relevance, one had HC of unknown relevance, and only two patients were discovered as having a prior unknown calcium metabolic disease. Three mismatches were observed in admissions with CaT ? 2.77 mmol/L. Mismatches did in none of these cases have any clinical consequences. Conclusion: By using CaT as a screening method for HC instead of CaI, only two patients with prior unrecognized HC would have been missed and it did not result in a large number of patients with false HC. We therefore find that CaT is an acceptable test when screening for HC in the ED. J Endocrinol Metab. 2021;11(5):108-114 doi: https://doi.org/10.14740/jem757","PeriodicalId":15712,"journal":{"name":"Journal of Endocrinology and Metabolism","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48445578","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}
A. Shaheer, Ashok Kumar, P. Menon, M. Jallo, S. Basha
Background: The alteration of adipokine secretion leads to the development of insulin resistance or impaired function of insulin in type 2 diabetes with obesity. The main objective of the study was to evaluate the effect of add-on therapy of dapagliflozin and empagliflozin on visceral fat-associated adipokines in inadequately controlled overweight and obese type 2 diabetic patients on metformin monotherapy. Methods: The study included 60 participants diagnosed with type 2 diabetes mellitus with overweight or obesity. The blood samples were taken before starting first-line therapy with metformin, 12 weeks after starting metformin therapy and 12 weeks after starting add-on therapy. The biochemical variables were analyzed using Cobas ® 6000 analyzer. Hemoglobin A1c (HbA1c) level was measured with high-performance liquid chromatography (HPLC). Serum adipokines were estimated with enzyme-linked immunosorbent assay (ELISA). Results: The mean adiponectin level was significantly elevated with add-on therapy using dapagliflozin and empagliflozin (P < 0.001). The mean fatty-acid binding protein 4 (FABP4), retinol-binding protein 4 (RBP4) and visfatin levels were reduced considerably (P < 0.001). The mean HbA1c, fasting plasma glucose (FPG) and postprandial blood glucose (PPBG) levels were reduced significantly with add-on therapy (P < 0.001). Lipid profile and creatinine were also altered significantly with the add-on therapy (P < 0.001). Conclusions: Add-on therapy of dapagliflozin and empagliflozin are beneficial to control the adipokines that regulate the visceral fat in overweight and obese type 2 diabetic patients. The effective therapeutic target to control adipokines with metabolic variables reduces body weight, obesity, cardiovascular risk and renal disease in type 2 diabetes. J Endocrinol Metab. 2021;11(3-4):83-90 doi: https://doi.org/10.14740/jem751
{"title":"Effect of Add-On Therapy of Dapagliflozin and Empagliflozin on Adipokines in Type 2 Diabetes Mellitus","authors":"A. Shaheer, Ashok Kumar, P. Menon, M. Jallo, S. Basha","doi":"10.14740/jem751","DOIUrl":"https://doi.org/10.14740/jem751","url":null,"abstract":"Background: The alteration of adipokine secretion leads to the development of insulin resistance or impaired function of insulin in type 2 diabetes with obesity. The main objective of the study was to evaluate the effect of add-on therapy of dapagliflozin and empagliflozin on visceral fat-associated adipokines in inadequately controlled overweight and obese type 2 diabetic patients on metformin monotherapy. Methods: The study included 60 participants diagnosed with type 2 diabetes mellitus with overweight or obesity. The blood samples were taken before starting first-line therapy with metformin, 12 weeks after starting metformin therapy and 12 weeks after starting add-on therapy. The biochemical variables were analyzed using Cobas ® 6000 analyzer. Hemoglobin A1c (HbA1c) level was measured with high-performance liquid chromatography (HPLC). Serum adipokines were estimated with enzyme-linked immunosorbent assay (ELISA). Results: The mean adiponectin level was significantly elevated with add-on therapy using dapagliflozin and empagliflozin (P < 0.001). The mean fatty-acid binding protein 4 (FABP4), retinol-binding protein 4 (RBP4) and visfatin levels were reduced considerably (P < 0.001). The mean HbA1c, fasting plasma glucose (FPG) and postprandial blood glucose (PPBG) levels were reduced significantly with add-on therapy (P < 0.001). Lipid profile and creatinine were also altered significantly with the add-on therapy (P < 0.001). Conclusions: Add-on therapy of dapagliflozin and empagliflozin are beneficial to control the adipokines that regulate the visceral fat in overweight and obese type 2 diabetic patients. The effective therapeutic target to control adipokines with metabolic variables reduces body weight, obesity, cardiovascular risk and renal disease in type 2 diabetes. J Endocrinol Metab. 2021;11(3-4):83-90 doi: https://doi.org/10.14740/jem751","PeriodicalId":15712,"journal":{"name":"Journal of Endocrinology and Metabolism","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2021-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45642964","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}
Inborn errors of metabolism (IEM) are a group of disorders that are often erroneously assumed to be the playing field of pediatricians only. This misconception combined with the rare nature of IEMs explains why there is often a serious delay in the diagnosis of an adult-onset IEM, which can have detrimental consequences. This review provides potential strategies to overcome this diagnostic delay. The most promising consists of stimulating critical clinical reasoning and creating awareness of the process that leads to the diagnosis of a rare disease. J Endocrinol Metab. 2021;11(3-4):65-68 doi: https://doi.org/10.14740/jem750
{"title":"When to Consider an Inborn Error of Metabolism in Adults?","authors":"M. Brouwers","doi":"10.14740/jem750","DOIUrl":"https://doi.org/10.14740/jem750","url":null,"abstract":"Inborn errors of metabolism (IEM) are a group of disorders that are often erroneously assumed to be the playing field of pediatricians only. This misconception combined with the rare nature of IEMs explains why there is often a serious delay in the diagnosis of an adult-onset IEM, which can have detrimental consequences. This review provides potential strategies to overcome this diagnostic delay. The most promising consists of stimulating critical clinical reasoning and creating awareness of the process that leads to the diagnosis of a rare disease. J Endocrinol Metab. 2021;11(3-4):65-68 doi: https://doi.org/10.14740/jem750","PeriodicalId":15712,"journal":{"name":"Journal of Endocrinology and Metabolism","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2021-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45842718","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}
Pranav Sharma, Kareem K Elfatairy, Darshan Gandhi, Harpreet Sawhney, M. Osman, P. Kochar, Steven C. Cohen
Background: The purpose of this study was to retrospectively analyze the diagnostic performance of different international guidelines to detect benign from malignant nodules using fine-needle aspiration biopsy as a reference test. Methods: This study is a multi-institution, IRB-approved, retrospective study conducted from 2016 to 2020 that evaluated 200 consecutive biopsied thyroid nodules. The nodules were reclassified according to American College of Radiology Thyroid Imaging and Reporting Data System (ACR-TIRADS), Kwak-TIRADS (K-TIRADS), Korean Society of Thyroid Radiology (KSThR), European Thyroid Imaging and Reporting Data System (EU-TIRADS), and American Thyroid Association (ATA) guidelines. A Chi-squared test and receiver operating curve (ROC) with 95% confidence intervals and P-value < 0.05 were performed to calculate sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), false negative and unnecessary biopsy rate. The unnecessary biopsy rate was defined as the percentage of benign nodules among total biopsy-required nodules. Results: A total of 200 patients were included in this study. Patients aged from 23 to 74 years including 36 males and 164 females. The female/male ratio was 4.5:1. Female predominance was seen among most of the age groups. The cohort showed 26 (13%) malignant nodules and 174 (87%) benign nodules. A solid component was observed in the majority of malignant nodules (61.6%, P = 0.0376) and mixed component was observed in the majority of benign nodules (51.7%, P = 0.0376). There was no statistically significant difference in differentiating benign from malignant nodule with the echogenicity or orientation of the nodule. The statistically significant features of a benign nodule were spongiform appearance, no echogenic foci or comet tail and absence of peripheral halo (P < 0.03). The statistically significant features of a malignant nodule were a solid, peripheral halo, peripheral or punctate echogenic foci, microcalcification, and macrocalcification (P < 0.001). The ACR-TIRADS showed the highest specificity (40.23% (95% confidence interval (CI) 32 - 47)), PPV (18.75 (95% CI 0.12 - 0.26)), NPV (97.22 (95% CI 0.90 - 0.99)) and area under the curve (AUC) (0.6627 (95% CI 0.59 - 0.72)). This was closely followed by ATA which demonstrated the PPV of 17.39 (95% CI 0.11 - 0.24), NPV of 96.77 (95% CI 0.89 - 0.99) and AUC of 0.6340 (95% CI 0.57 - 0.69). The K-TIRADS has the highest sensitivity (96.15% (95% CI 80 - 99)). Lowest unnecessary biopsy rates were found with ACR-TIRADS (104 (52%) (P = 0.0013)) and KSThR guidelines (114 (57%) (P = 0.0059)) and highest with K-TIRADS (160 (80%) (P = 0.4482)). Conclusion: We found that diagnostic performance of ACR and ATA guidelines is higher and is a practical method for assessing thyroid nodules in routine practice. Both these guidelines can avoid unnecessary biopsies in a significant proportion of benign thyroid lesions. ACR-TIRADS is also very specifi
{"title":"Diagnostic Performance of ACR-TIRADS in Differentiating Benign From Malignant Thyroid Nodules in Patients Undergoing Fine-Needle Aspiration Biopsy: Comparative Study Based on Five International Guidelines for Management of Thyroid Nodules","authors":"Pranav Sharma, Kareem K Elfatairy, Darshan Gandhi, Harpreet Sawhney, M. Osman, P. Kochar, Steven C. Cohen","doi":"10.14740/jem735","DOIUrl":"https://doi.org/10.14740/jem735","url":null,"abstract":"Background: The purpose of this study was to retrospectively analyze the diagnostic performance of different international guidelines to detect benign from malignant nodules using fine-needle aspiration biopsy as a reference test. Methods: This study is a multi-institution, IRB-approved, retrospective study conducted from 2016 to 2020 that evaluated 200 consecutive biopsied thyroid nodules. The nodules were reclassified according to American College of Radiology Thyroid Imaging and Reporting Data System (ACR-TIRADS), Kwak-TIRADS (K-TIRADS), Korean Society of Thyroid Radiology (KSThR), European Thyroid Imaging and Reporting Data System (EU-TIRADS), and American Thyroid Association (ATA) guidelines. A Chi-squared test and receiver operating curve (ROC) with 95% confidence intervals and P-value < 0.05 were performed to calculate sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), false negative and unnecessary biopsy rate. The unnecessary biopsy rate was defined as the percentage of benign nodules among total biopsy-required nodules. Results: A total of 200 patients were included in this study. Patients aged from 23 to 74 years including 36 males and 164 females. The female/male ratio was 4.5:1. Female predominance was seen among most of the age groups. The cohort showed 26 (13%) malignant nodules and 174 (87%) benign nodules. A solid component was observed in the majority of malignant nodules (61.6%, P = 0.0376) and mixed component was observed in the majority of benign nodules (51.7%, P = 0.0376). There was no statistically significant difference in differentiating benign from malignant nodule with the echogenicity or orientation of the nodule. The statistically significant features of a benign nodule were spongiform appearance, no echogenic foci or comet tail and absence of peripheral halo (P < 0.03). The statistically significant features of a malignant nodule were a solid, peripheral halo, peripheral or punctate echogenic foci, microcalcification, and macrocalcification (P < 0.001). The ACR-TIRADS showed the highest specificity (40.23% (95% confidence interval (CI) 32 - 47)), PPV (18.75 (95% CI 0.12 - 0.26)), NPV (97.22 (95% CI 0.90 - 0.99)) and area under the curve (AUC) (0.6627 (95% CI 0.59 - 0.72)). This was closely followed by ATA which demonstrated the PPV of 17.39 (95% CI 0.11 - 0.24), NPV of 96.77 (95% CI 0.89 - 0.99) and AUC of 0.6340 (95% CI 0.57 - 0.69). The K-TIRADS has the highest sensitivity (96.15% (95% CI 80 - 99)). Lowest unnecessary biopsy rates were found with ACR-TIRADS (104 (52%) (P = 0.0013)) and KSThR guidelines (114 (57%) (P = 0.0059)) and highest with K-TIRADS (160 (80%) (P = 0.4482)). Conclusion: We found that diagnostic performance of ACR and ATA guidelines is higher and is a practical method for assessing thyroid nodules in routine practice. Both these guidelines can avoid unnecessary biopsies in a significant proportion of benign thyroid lesions. ACR-TIRADS is also very specifi","PeriodicalId":15712,"journal":{"name":"Journal of Endocrinology and Metabolism","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2021-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42540470","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}
M. Aboelnaga, A. Abdelrazek, N. Abdullah, M. El Shaer
Background: Recent studies reported lower androgen levels in coronavirus disease 2019 (COVID-19) hospitalized patients which linked to a worse prognosis. However, these studies were conducted in patients with active disease and long-term consequences are still not yet known. Therefore, we aimed to evaluate the late impact of COVID-19 pneumonia on testosterone levels in late recovered, post-hospitalized males. Methods: We enrolled 55 COVID-19 pneumonia-recovered, post-hospitalized male patients after an average of 60 days of discharge from the hospital and 40 age, body mass index (BMI), and waist-matched participants enrolled in this case-control study. The total testosterone cut-off point was set as 300 ng/dL and the cut-off point for luteinizing hormone (LH) was set as 9.4 IU/L. Results: Testosterone deficiency prevalence was 50.9%, and testosterone deficiency was mainly hypogonadotropic (60.7%). Late recovered COVID-19 pneumonia patients had significantly lower total testosterone and calculated free testosterone and higher testosterone to LH ratio and prevalence of testosterone deficiency in comparison with the control group. Testosterone-deficient COVID-19 pneumonia patients had significantly higher anthropometric parameters such as waist circumference and BMI, higher Charlson Comorbidity Index, and longer hospitalization time in comparison with testosterone-sufficient patients. Visceral obesity estimated with waist circumference was a significant predictor for total testosterone levels in COVID patients in regression analysis. Conclusion: Late recovered post-hospitalized COVID-19 pneumonia patients still have lower androgen levels and a higher prevalence of testosterone deficiency in comparison with matched control participants. Moreover, visceral obesity was the most significant predictor of low testosterone levels in recovered COVID-19 patients. J Endocrinol Metab. 2021;11(3-4):76-82 doi: https://doi.org/10.14740/jem749
{"title":"Late Impact of COVID-19 Pneumonia on Testosterone Levels in Recovered, Post-Hospitalized Male Patients","authors":"M. Aboelnaga, A. Abdelrazek, N. Abdullah, M. El Shaer","doi":"10.14740/jem749","DOIUrl":"https://doi.org/10.14740/jem749","url":null,"abstract":"Background: Recent studies reported lower androgen levels in coronavirus disease 2019 (COVID-19) hospitalized patients which linked to a worse prognosis. However, these studies were conducted in patients with active disease and long-term consequences are still not yet known. Therefore, we aimed to evaluate the late impact of COVID-19 pneumonia on testosterone levels in late recovered, post-hospitalized males. Methods: We enrolled 55 COVID-19 pneumonia-recovered, post-hospitalized male patients after an average of 60 days of discharge from the hospital and 40 age, body mass index (BMI), and waist-matched participants enrolled in this case-control study. The total testosterone cut-off point was set as 300 ng/dL and the cut-off point for luteinizing hormone (LH) was set as 9.4 IU/L. Results: Testosterone deficiency prevalence was 50.9%, and testosterone deficiency was mainly hypogonadotropic (60.7%). Late recovered COVID-19 pneumonia patients had significantly lower total testosterone and calculated free testosterone and higher testosterone to LH ratio and prevalence of testosterone deficiency in comparison with the control group. Testosterone-deficient COVID-19 pneumonia patients had significantly higher anthropometric parameters such as waist circumference and BMI, higher Charlson Comorbidity Index, and longer hospitalization time in comparison with testosterone-sufficient patients. Visceral obesity estimated with waist circumference was a significant predictor for total testosterone levels in COVID patients in regression analysis. Conclusion: Late recovered post-hospitalized COVID-19 pneumonia patients still have lower androgen levels and a higher prevalence of testosterone deficiency in comparison with matched control participants. Moreover, visceral obesity was the most significant predictor of low testosterone levels in recovered COVID-19 patients. J Endocrinol Metab. 2021;11(3-4):76-82 doi: https://doi.org/10.14740/jem749","PeriodicalId":15712,"journal":{"name":"Journal of Endocrinology and Metabolism","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2021-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44539673","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}
Prolactinomas are the most common functional pituitary tumors and present with elevated serum prolactin levels. This may or may not be accompanied by mass-related clinical symptoms. Dopamine agonists are its principal treatment. Data on prolactinoma remission and relapse after treatment withdrawal are limited. Here we report a patient presenting with headache, amenorrhea, galactorrhea, visual field impairments and a high serum prolactin level. After a definitive diagnosis of pituitary macroadenoma, the patient was treated with bromocriptine. Twelve months after treatment, tumor size markedly reduced, there was resolution of symptoms and patient was eventually lost to follow-up. After 10 months without treatment, tumor recurred. Bromocriptine was resumed for 5 more years and discontinued thereafter. Since then, the patient has been asymptomatic for the past 12 years; surveillance imaging showed no tumor recurrence with annual prolactin level all within normal range. This case adds to the limited data confirming that dopamine agonists in patients with prolactinomas can be successfully discontinued with a high remission rate, provided that there is adequate duration of treatment and sufficient follow-up. J Endocrinol Metab. 2021;11(3-4):91-93 doi: https://doi.org/10.14740/jem753
{"title":"The Vanishing Pituitary Tumor: A Case Report","authors":"Ainee Krystelle C. Lee, N. Chua, R. Ramos","doi":"10.14740/jem753","DOIUrl":"https://doi.org/10.14740/jem753","url":null,"abstract":"Prolactinomas are the most common functional pituitary tumors and present with elevated serum prolactin levels. This may or may not be accompanied by mass-related clinical symptoms. Dopamine agonists are its principal treatment. Data on prolactinoma remission and relapse after treatment withdrawal are limited. Here we report a patient presenting with headache, amenorrhea, galactorrhea, visual field impairments and a high serum prolactin level. After a definitive diagnosis of pituitary macroadenoma, the patient was treated with bromocriptine. Twelve months after treatment, tumor size markedly reduced, there was resolution of symptoms and patient was eventually lost to follow-up. After 10 months without treatment, tumor recurred. Bromocriptine was resumed for 5 more years and discontinued thereafter. Since then, the patient has been asymptomatic for the past 12 years; surveillance imaging showed no tumor recurrence with annual prolactin level all within normal range. This case adds to the limited data confirming that dopamine agonists in patients with prolactinomas can be successfully discontinued with a high remission rate, provided that there is adequate duration of treatment and sufficient follow-up. J Endocrinol Metab. 2021;11(3-4):91-93 doi: https://doi.org/10.14740/jem753","PeriodicalId":15712,"journal":{"name":"Journal of Endocrinology and Metabolism","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2021-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46967381","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}
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