Minerva endocrinology最新文献

Background: The aim of our retrospective study was to describe the immunophenotypic characteristics of neuroendocrine breast neoplasm (BNEN), a peculiar and rare type of breast carcinoma.

Methods: Pathological data from 51 patients affected by BNEN were retrospectively evaluated, and 44 patients were considered eligible (7 patients with incomplete data were excluded). The patients were followed in six different Italian hospitals between 2009 and 2019. The histological samples, collected by biopsies and/or surgery pieces, were analyzed to determine: 1) tumor histology; 2) immunophenotypic pattern; 3) presence of lymphatic infiltration; 4) presence of necrosis.

Results: The median age of the patients included in our analysis was 70 years (67.6±13.7 years). As concerns the histological type we identified 7 cases of well-differentiated neuroendocrine carcinomas (16%), 8 cases of poorly differentiated/small cell neuroendocrine carcinoma (18%), 29 cases of breast carcinomas with neuroendocrine differentiation (66%). From the analysis of breast-specific immunophenotype we identified: 24 cases (54%) of Luminal A pattern; 9 cases (20%) of Luminal B pattern; 8 case (18%) of triple negative pattern. The presence of lymphatic infiltration was assessed in 29 samples and it was observed in 13 cases (45%), necrosis was assessed in 29 samples and was absent in 72% of all cases (21 samples). Neuroendocrine markers expression was heterogeneous with a prevalence of synaptophysin (positivity in 95%); chromogranin A was evaluated in 31 samples and it was positive in 58% of cases.

Conclusions: in our series BNENs mainly affect a post-menopausal population and luminal A pattern is the most frequent immunophenotype. As expected, lymphatic infiltration is most frequently reported in invasive breast cancer with neuroendocrine differentiation; necrosis is absent in well-differentiated neuroendocrine carcinomas. Synaptophysin and chromogranin A are important markers for the diagnosis of BNEN.

Background: Bariatric surgery (BS) stands as a highly effective intervention for severe obesity; however, limited understanding exists regarding its short to medium-term complications. This study aimed to analyze short-medium term complications in patients undergoing BS in an Ecuadorian hospital.

Methods: A retrospective cohort study included 1132 patients who underwent BS between October 2021 and April 2022, specifically evaluating those with complications needing hospital readmission. Demographic, clinical, surgical, and therapeutic data were collected. The degree of complications was evaluated using the Clavien-Dindo classification.

Results: Out of the 1132 patients, 1.6% experienced early complications requiring hospital readmission within the first six months post-BS. Complications occurred in 7% of patients with revisional surgery, 2% with gastric bypass, and 1.2% with gastric sleeve. The most common complications were stenosis (28%), leaks/fistulas (17%), gallbladder and/or bile duct pathologies (17%), and fever (17%). Management strategies involved conservative treatment (28%), combined endoscopic and surgical approaches (28%), and surgical reintervention alone (33%). According to the Clavien-Dindo classification, 28% presented mild-moderate and 72% serious complications.

Conclusions: BS showed a low incidence of early complications that required readmission. However, a substantial proportion (almost 70%) of patients with early complications experienced severe ones, resulting in prolonged hospital stays. These findings emphasize the need for ongoing monitoring and specialized care in the postoperative period, contributing valuable insights to the safety profile of BS in an Ecuadorian context.

Introduction: Diabetic retinopathy (DR) is a common microvascular complication of diabetes. This review reports the prevalence of DR in Asia and guides healthcare provision in screening and treatment.

Evidence acquisition: Medline was searched for articles describing the prevalence of DR in Asia. Statistical analysis was performed using Freeman-Tukey double arcsine transformation and the DerSimonian and Laird model. The prevalence of DR was estimated according to the following subgroups: Economic status (high, middle, and low income), country, and ethnicity. The risk of bias of the articles was also assessed.

Evidence synthesis: A total of 66 studies were included, and out of 2,599,857 patients with diabetes, 201,646 were diagnosed with DR. The overall prevalence of DR, non-proliferative DR (NPDR), proliferative DR (PDR) and maculopathy were recorded at 21.7% (CI: 19.1-24.6%), 19.9% (CI: 17.3-22.8%), 2.3% (CI: 1.6-3.4%) and 4.8% (CI: 3.5-6.7%) respectively. Low-income countries had the lowest prevalence of DR, NPDR, PDR and maculopathy compared to the middle- and high-income countries. Middle-income countries had the highest prevalence of DR (23.9%; CI: 19.4-29.2%), NPDR (21.1%; CI: 17.0-25.9%), moderate NPDR (7.9%; CI: 5.7-11.0%), PDR (3.0%; CI: 1.8-4.9%) and maculopathy (4.7%; CI: 3.0-7.4%), while high-income countries had the highest prevalence of mild (10.3%; CI: 4.2-23.2%) and severe NPDR (3.0%; CI: 1.0-8.4%).

Conclusions: One in five people with diabetes have diabetic retinopathy. It is imperative that public healthcare take heeds to heighten the screening program to provide all patients with diabetes equitable access to DR screening and ophthalmology services.

Background: Previous studies have investigated the correlation between diabetes and HPV vaccination; however, there is little evidence about the association between viral infection and diabetes. This study aims to investigate the association between diabetes and human papillomavirus infection.

Methods: Using the USA National Health and Nutrition Examination Survey (2015-2016), records of 571 diabetic and 4170 non‑diabetic patients were extracted. Comparative analyses were used to evaluate differences in the HPV testing results between the two groups. Multivariate logistic regression analyses were used to evaluate independent risk factors for diabetes among all subjects.

Results: Positive tests were detected in 6.7% of the oral HPV, 19.5% of the Cobas^® HPV swab (high-risk group), 40.9% of the Roche^® HPV linear array (vaginal swab), and 43.8% of the Roche^® HPV linear array (penile swab). The results of multivariate regression analysis, after adjusting for age, gender, race, marital status, and presence of comorbidities, showed no statistically significant association between positive or negative HPV testing and presence of diabetes mellitus, with an exception for the penile swab using Roche^® HPV linear array (P=0.020).

Conclusions: This retrospective database study of HPV infection and diabetes showed no significant association between patients with HPV and those with diabetes.

Introduction: There has been a dramatic increase in the practice of shift work throughout the world. It is known to associate with several adverse health outcomes including increased adiposity. The present study aims to systematically evaluate the literature to find the associations between exposure to shift work and body composition.

Evidence acquisition: Data were obtained using a stepwise search process using keywords in the following online medical databases; PubMed^®, Web of Science^® and Scopus^® for studies published before 31^st March 2020. Studies which compared the outcome related to the body composition of shift workers and regular day workers were included. A meta-analysis was performed on body fat percentage (BF%).

Evidence synthesis: Initial database searching indicated 2311 potentially eligible articles, of which seven studies satisfying the inclusion criteria were selected. The number of participants ranged between 17 to 7318, and the age range of the subjects was between 20-65 years. The studies reported diverse shift schedules including rotating shifts, night, evening shifts, alternate shifts, and regular shifts. Four out of seven studies revealed a higher BF% in shift workers when compared to the non-shift group. The pooled mean difference for BF% between shift workers and regular workers was 1.77% (95% CI: 0.18, 3.35; P=0.03; I²=52%, P>0.12).

Conclusions: The meta-analysis of the review showed a significant increase in BF% of shift workers when compared to the non-shift group. However, individual studies showed considerable heterogeneity. Therefore in order to further clarify the underlying mechanisms, more and better quality studies on this field are necessary.

Background: Uncontrolled increase in reactive oxygen species (ROS) leads to the release of free radicals. Additionally, when antioxidants go below a certain level, major molecules of our system such as DNA, proteins, and many other macromolecules get damaged, leading to cancer, heart diseases, and metabolic syndromes like diabetes. Therefore, in our study we focused on: 1) newly diagnosed type 2 diabetes mellitus (T2DM) patients and tried to evaluate the expression of antioxidant enzyme encoding genes; 2) superoxide dismutase 1 (SOD1) and superoxide dismutase 2 (SOD2) and DNA repair genes; and 3) X-ray repair cross-complementing 1(XRCC1) and 8-oxoguanine DNA glycosylase 1 (OGG1) in them.

Methods: Expression analysis was performed by RT-PCR on 60 subjects (30 T2DM cases and 30 non-diabetic controls). The level of the SOD enzyme was also estimated in a serum sample by the colorimetric method. Biochemical parameters such as fasting plasma glucose (FBG), glycated haemoglobin (HbA1c), high sensitivity C-reactive protein (hsCRP), and lipid profile were estimated in an auto analyzer. Receiver operating characteristic (ROC) curve analysis was done, the area under the curve for mRNA expression and enzyme level was calculated to determine their potential as markers in newly diagnosed T2DM.

Results: Down-regulation of both SOD1 (0.43 fold, P=0.02) and SOD2 (0.41 fold, P=0.13) and up-regulation of both XRCC1 (1.15 fold, P>0.05) and OGG1 (1.49 fold, P>0.05) was observed in patients with T2DM. We also observed a significant decrease (P=0.02) in SOD enzyme levels in diabetic cases than in controls (599.8±178.9 and 691.3±127.3).

Conclusions: We report that antioxidant repair genes are downregulated and DNA repair genes are upregulated in newly diagnosed T2DM patients. SOD levels and SOD1 gene expression can serve as informative biomarkers for identifying T2DM patients.

Introduction: Linagliptin is a convenient and effective drug approved for glycemic management in type 2 diabetes mellitus (T2DM). However, the effectiveness and safety evidence of linagliptin remains unclear with the increasing prevalence of T2DM in elderly patients. The aim of this study was to evaluate the effectiveness and safety of linagliptin within T2DM cases who aged ≥60 years.

Evidence acquisition: The researchers pooled 4903 cases aged ≥60 years with T2DM from 5 published randomized clinical trials obtained from multiple databases. The safety was evaluated by the incidence and severity of adverse events which mainly focused on hypoglycemia. The major effectiveness end point was the change of glycated hemoglobin (HbA1c). Then the researchers made the qualitative and quantitative assessments of the investigation.

Evidence synthesis: The level of HbA1c and fasting plasma glucose was significantly reduced by linagliptin (WMD=-0.63%, 95% CI: -0.81, -0.44; P<0.00001; Z=6.70) and (WMD=-15.58 mg/dL, 95% CI: -22.34, -8.82; P<0.00001; Z=4.52) relative to that in the placebo cohort. The incidences of overall (OR=1.01, 95% CI: 0.82, 1.25; P=0.91) and severe negative events (OR=0.88, 95% CI: 0.61, 1.25; P=0.46) were not significant increased in linagliptin cohorts compared to the placebo cohorts. There is insignificant difference in hypoglycemia between linagliptin and placebo cohorts for the 24 weeks' study (OR=1.12, 95% CI: 0.85, 1.48; P=0.41). Severe hypoglycemia had slightly descended incidence, whereas insignificant difference was shown in the linagliptin cohorts in contrast to placebo cohorts (OR=0.95, 95% CI: 0.68, 1.32, P=0.76).

Conclusions: Linagliptin is an effective drug with excellent safety for elderly T2DM.

Introduction: Obesity is intricately linked with metabolic conditions that disrupt hormones and metabolism, often resulting in weight-related challenges. Given the heightened mortality rates associated with cardiovascular and metabolic disorders linked to obesity, there is a pressing call to mobilize medical professionals, researchers, and policymakers towards advocating for healthy lifestyles and preventing obesity. Traditionally, obesity prevention and treatment have been viewed as separate endeavors, with prevention primarily falling under public health initiatives and treatment within the purview of clinicians. However, this division has led to significant healthcare costs without a substantial reduction in obesity rates.

Evidence acquisition: Our search encompassed published articles focused on prevention, excluding any mention of "treatment". Data was gathered from diverse sources including academic databases, government health agency websites like the CDC, research organizations, clinical trials registries, and public health campaigns.

Evidence synthesis: Due to the diverse range of interventions (encompassing dietary modifications, physical activity promotion, policy initiatives, education, and community-based programs, either independently or in combination), and the variability in study design and population demographics, we conducted a narrative review to systematically present and critically analyze evidence on preventing overweight and obesity across different age groups.

Conclusions: Effectively addressing obesity prevention necessitates a comprehensive, multidisciplinary approach that establishes an environment where healthier choices are accessible and viable for all. This requires collaborative efforts between individuals, communities, healthcare providers, policymakers, and industries to institute enduring change. Furthermore, there remains a critical need for national and international guidelines tailored to age-related risk factors, paving the way for innovative precision medicine approaches centered on salutogenesis rather than pathogenesis.