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Potential Role of Dexamphetamine in the Treatment of Non-alcoholic Fatty Liver Disease: Hopes and Pitfalls. 右旋苯丙胺在治疗非酒精性脂肪肝中的潜在作用:希望与缺陷
Pub Date : 2021-04-01 Epub Date: 2021-04-28 DOI: 10.17925/EE.2021.17.1.33
C S Gautam, Jatin Sharma, Mandeep Singla, Ilmjot Kaur Tiwana, Harmanjit Singh

Non-alcoholic fatty liver disease (NAFLD) is one of most frequent causes of chronic liver disease. Global prevalence of NAFLD and nonalcoholic steatohepatitis (NASH) with advanced fibrosis is increasing day by day. Patients with NAFLD are more susceptible to encounter cardiovascular morbidity and mortality. Apart from lifestyle changes and dietary modifications, no effective pharmacotherapy is available to prevent the progression of NAFLD to NASH and advanced stages of hepatic fibrosis and cirrhosis. Dexamphetamine is the d-isomer of amphetamine, which acts by inhibiting monoamine reuptake and direct stimulation of dopamine and noradrenaline release. Presently, dexamphetamine is indicated for the treatment of attention deficit hyperactivity disorder and narcolepsy, but since its use was found to be associated with weight loss, it is also now used as an off-label drug for the treatment of obesity. Direct or indirect evidence is present in the form case reports, case series and from effects of related drugs to support the potential role of dexamphetamine in NAFLD. There is an urgent need to initiate preclinical and clinical studies involving robust methodology and adequate sample sizes to explore the potential of dexamphetamine in patients with NAFLD. In this review, we will discuss the therapeutic potential of dexamphetamine for the treatment of NAFLD.

非酒精性脂肪性肝病(NAFLD)是慢性肝病最常见的病因之一。NAFLD和非酒精性脂肪性肝炎(NASH)伴晚期纤维化的全球患病率日益增加。NAFLD患者更容易发生心血管疾病和死亡。除了生活方式的改变和饮食的改变,没有有效的药物治疗可用于预防NAFLD进展为NASH和晚期肝纤维化和肝硬化。右旋安非他明是安非他明的d型异构体,通过抑制单胺再摄取和直接刺激多巴胺和去甲肾上腺素的释放而起作用。目前,右安非他明被用于治疗注意力缺陷多动障碍和嗜睡症,但由于它的使用被发现与体重减轻有关,它现在也被用作治疗肥胖的标签外药物。直接或间接的证据以病例报告、病例系列和相关药物效应的形式存在,支持右安非他明在NAFLD中的潜在作用。迫切需要开展临床前和临床研究,包括可靠的方法和足够的样本量,以探索右安非他明在NAFLD患者中的潜力。在这篇综述中,我们将讨论右安非他明治疗NAFLD的治疗潜力。
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引用次数: 1
Clinical, Metabolic and Hormonal Profiles of Bangladeshi Adolescents with Polycystic Ovary Syndrome. 孟加拉国多囊卵巢综合征青少年的临床、代谢和激素概况
Pub Date : 2021-04-01 Epub Date: 2021-04-28 DOI: 10.17925/EE.2021.17.1.54
Abm Kamrul-Hasan, Fatema Tuz Zahura Aalpona, Shahjada Selim

Background: The features of polycystic ovary syndrome (PCOS) vary greatly among adolescent girls and adult women. Some of the features of PCOS may overlap with features of normal pubertal development in girls. Methods: This cross-sectional study was conducted among adolescents newly diagnosed with PCOS attending a tertiary hospital in Bangladesh. The relevant clinical, metabolic and hormonal profiles of 175 participants were evaluated. Results: The mean age of the study participants was 16.8 (±1.7) years. Oligomenorrhea was the predominant menstrual irregularity (88%). More than one-quarter of participants (27.4%) had a first-degree relative with PCOS, and 12% had a first-degree relative with type 2 diabetes. More than three-quarters (77.7%) had acanthosis nigricans. The majority (69.1%) were overweight (29.7%) or obese (39.4%), whereas 6.3% were underweight. A total of 65.7% had abdominal obesity. One-fifth (20%) of participants had pre-hypertension, and 3.4% were hypertensive. Around one-quarter (24%) had abnormal glucose tolerance (prediabetes 21.1%, diabetes 2.9%) and the majority (90.9%) had dyslipidaemia. The median Ferriman-Gallwey score was 12, 94.9% of participants had hirsutism and 33.7% had biochemical hyperandrogenism. Metabolic syndrome was present in 42.3% of participants. Higher body mass index and presence of hirsutism were associated with higher risks of metabolic syndrome. Conclusions: The clinical, metabolic and hormonal profiles of Bangladeshi adolescents with PCOS highlight risk factors and the need for clinical vigilance with respect to metabolic disease.

背景:青春期少女和成年女性多囊卵巢综合征(PCOS)的特征差异很大。多囊卵巢综合征的一些特征可能与女孩正常青春期发育的特征重叠。方法:本横断面研究在孟加拉国一家三级医院新诊断为多囊卵巢综合征的青少年中进行。对175名参与者的相关临床、代谢和激素状况进行了评估。结果:研究参与者的平均年龄为16.8(±1.7)岁。经期不调以少经为主(88%)。超过四分之一(27.4%)的参与者有一级亲属患有多囊卵巢综合征,12%的参与者有一级亲属患有2型糖尿病。超过四分之三(77.7%)的人患有黑棘皮病。大多数人(69.1%)超重(29.7%)或肥胖(39.4%),而体重不足(6.3%)。腹部肥胖占65.7%。五分之一(20%)的参与者有高血压前期,3.4%的参与者有高血压。大约四分之一(24%)的患者有糖耐量异常(糖尿病前期21.1%,糖尿病2.9%),大多数(90.9%)有血脂异常。Ferriman-Gallwey评分中位数为12,94.9%的参与者有多毛症,33.7%的参与者有生化性高雄激素症。42.3%的参与者存在代谢综合征。较高的身体质量指数和多毛症的存在与较高的代谢综合征风险相关。结论:孟加拉国多囊卵巢综合征青少年的临床、代谢和激素特征突出了危险因素,需要对代谢性疾病保持临床警惕。
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引用次数: 4
Assessment of Early Markers of Cardiovascular Risk in Polycystic Ovary Syndrome. 多囊卵巢综合征心血管风险早期标志物的评估。
Pub Date : 2021-04-01 Epub Date: 2021-04-28 DOI: 10.17925/EE.2021.17.1.37
Krystallenia I Alexandraki, Eleni A Kandaraki, Kalliopi-Anna Poulia, Christina Piperi, Eirini Papadimitriou, Theodoros G Papaioannou

Polycystic ovary syndrome (PCOS) is a heterogeneous syndrome, with long-term sequelae from birth to senescence. The long-term effects of PCOS are attributed to several metabolic aberrations ensuing the syndrome. In a systematic review of literature regarding the cardiovascular risk factors that accompany PCOS, we found that macrovascular function has been assessed by flow-mediated dilatation (FMD), microvascular function by venous occlusion plethysmography (VOP), and arterial structure by ultrasonographic assessment of intima-media thickness (IMT) usually of the carotid artery. Contradictory results have been reported; however, in most studies, endothelial dysfunction, an early marker of atherosclerosis assessed either by haemodynamic methods such as FMD or by biochemical methods such as endothelin-1 levels, was found to be impaired. VOP is a less-studied method, with few indices altered. IMT was found to be altered in most of the included studies, but the population was more heterogeneous. Inflammatory markers, including C-reactive protein, were also found to be altered in most studies. On the other hand, a number of interventions have been shown beneficial for the markers of cardiovascular risk, in the context of insulin-sensitizers. However, other interventions such as oral contraceptive pills or statins did not consistently show a similar beneficial effect. In summary, the early identification and eventual treatment of cardiovascular clinical and biochemical risk factors may be used in clinical practice to prevent potential 'silent' triggers of cardiovascular disease.

多囊卵巢综合征(PCOS)是一种异质性综合征,具有从出生到衰老的长期后遗症。多囊卵巢综合征的长期影响是由于几种代谢异常引起的综合征。在系统回顾了有关PCOS伴有心血管危险因素的文献后,我们发现大血管功能通过血流介导扩张(FMD)评估,微血管功能通过静脉闭塞容积描画(VOP)评估,动脉结构通过超声评估颈动脉内膜-中膜厚度(IMT)评估。报道了相互矛盾的结果;然而,在大多数研究中,通过血流动力学方法(如FMD)或生化方法(如内皮素-1水平)评估的动脉粥样硬化的早期标志物内皮功能障碍被发现受损。VOP是一种研究较少的方法,几乎没有改变指标。在大多数纳入的研究中,发现IMT发生了改变,但人群的异质性更大。在大多数研究中,包括c反应蛋白在内的炎症标志物也被发现发生了改变。另一方面,在胰岛素增敏剂的背景下,许多干预措施已被证明对心血管风险标志物有益。然而,其他干预措施,如口服避孕药或他汀类药物并没有始终显示出类似的有益效果。总之,心血管临床和生化危险因素的早期识别和最终治疗可用于临床实践,以预防潜在的“沉默”触发心血管疾病。
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引用次数: 2
Screening for Hereditary Pheochromocytoma in a Patient with Neurofibromatosis Type 1: A Case Report. 1型神经纤维瘤病患者遗传性嗜铬细胞瘤筛查1例报告。
Pub Date : 2021-04-01 Epub Date: 2021-04-28 DOI: 10.17925/EE.2021.17.1.79
Inês Isabel Ferreira Barros, Fernando Manso, Ana Isabel Caldas E Silva, Maria Ramires Silva Lopes Pereira

Pheochromocytoma (PHEO) is a rare tumour that arises from adreno-medullary chromaffin cells and secretes catecholamines. These hormones are also secreted by paragangliomas, which derive from extra-adrenal cells of the sympathetic paravertebral ganglia. At least one-third of PHEOs are familial. Neurofibromatosis type 1 (NF1), or von Recklinghausen's disease, is diagnosed upon clinical criteria, and the study of PHEO is advised if hypertension is present. The incidence of PHEO in NF1 is 0.1-5.7% and explains hypertension in 20-50% of these patients. Recent advances in the treatment of this condition and preoperative preparation allow us to reduce its high cardiovascular morbimortality. Here we present the case of a 31-year-old female with known NF1 who presented with 5 months' history of non-specific symptoms and an episode of intraoperative hypertensive crisis. The workup detected a left sided PHEO, which was treated surgically. Our case illustrates the high prevalence of hereditary PHEO and how its presentation can go unnoticed. It reinforces the significance of screening for PHEO in patients with NF1.

嗜铬细胞瘤(PHEO)是一种罕见的肿瘤,起源于肾上腺髓质嗜铬细胞,分泌儿茶酚胺。这些激素也由副神经节瘤分泌,它来源于交感椎旁神经节的肾上腺外细胞。至少三分之一的pheo是家族性的。1型神经纤维瘤病(NF1),或von Recklinghausen病,根据临床标准诊断,如果存在高血压,建议进行PHEO研究。NF1中PHEO的发生率为0.1-5.7%,这解释了这些患者中20-50%的高血压。这种疾病的治疗和术前准备的最新进展使我们能够降低其高心血管死亡率。我们报告一例31岁女性NF1患者,有5个月的非特异性症状史和术中高血压危象发作。检查发现左侧PHEO,手术治疗。我们的病例说明了遗传性PHEO的高患病率以及它的表现如何被忽视。这加强了NF1患者PHEO筛查的重要性。
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引用次数: 0
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TouchREVIEWS in endocrinology
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