Endocrine, metabolic & immune disorders drug targets最新文献

Background: From 2021, PSDTA for women with pregnancy complicated by diabetes will be active in the ASL city of Turin; given the city's increasing multiculturalism, we decided to evaluate from this point of view the patients who entered this pathway.

Methods: Data on women from 1/10/2022 to 30/09/2023 were collected from the computerized medical record.

Results: Total patients: 304, Type of diabetes: T1D 3%; MODY < 1%; T2D 4% Diabetes manifested in pregnancy (DMIP) 2%, GDM 90%, Foreigners prevalence: GDM: 67%, T2D%, T1D: Foreign 11%, Planned vs. neglected pregnancies: GDM 47% vs 18%, T2D 31% vs 32%, DMIP 28% vs 50%, T1D: 66% vs 11%, Therapy: GDM: insulin 31% (multi-injective <30%), metformin 5%, T2D: insulin 100% (multi-injective 68%, metformin in 20%); continuous glycemic sensor in 48%, DMIP: insulin 50% (multi-injective 50%), T1D: multi-injective therapy 33%; pump and glycemic sensor 33%; integrated sensor-micro-infuser system 33%.

Conclusion: In the aspect of ISTAT data indicating that for northern Italy, a foreign origin for 26% of mothers, our population is "unbalanced" between GDM, T2D, and DMIP on one side and T1D on the other. The higher percentage of foreigners in the GDM group could be attributable to the higher share of Italian women opting for private practice, conversely, the "missing" share of foreign women with T1D is more difficult to interpret. Unplanned or even neglected pregnancies are significant in women with GDM and DMIP (who are mostly foreign). If these data are confirmed in other Italian realities, corrective strategies need to be planned.

Ultrasound-guided percutaneous Microwave Thermoablation (MWA) is an increasingly popular minimally invasive therapy for the treatment of benign thyroid nodules due to its remarkable heating velocity and resilience to heat sinking. We present a cohort of 26 patients (17 F, 9M, mean age 56.2yy) with 20 goiters (mean volume 34.9cc, min 6.5cc-max 84cc) and 6 autonomously functioning nodules (AFTNs, mean volume 11.6cc, min 3.5cc-max 24cc) treated with MWA, using the moving shot technique and a novel energy delivery algorithm (MONTREAL), based on intra-operative real-time reflectivity measurements: each moving shot was automatically terminated when reflectivity was observed to ramp up. 17G or 18G internally cooled 2.45 GHz applicators were used (AMICA-PROBE, HS HOSPITAL SERVICE SpA), operated at 15-30W. On average, each treatment deposited 9.9±5.5kJ during 696±325s, through 26.7±14.4 moving shots: the mean moving shot duration was 28.1±9.0s, yielding a mean ablation time per unit nodule volume of 34.3±19.1s/cc. No mild nor severe complications were recorded. Post-MWA ultrasound follow-up showed a mean volume reduction ratio of 59.1±10.2% [min 44% - max 80%] at 3 months and of 70.1±8.5% [min 53% - max 91%] at 6 months, with slightly better outcomes in the AFTNs sub-group (volume reduction of 65.3±10.2%/76.0±4.0% at 3/6 months and, in all cases, normal TSH values at 3 months upon pharmacological therapy suspension). MWA treatments of benign nodules with the MONTREAL technique appeared to be safe, fast, and effective. Further research is warranted to confirm these preliminary results.

Introduction: Any cancer diagnosis induces fear and shocking emotional experiences accompanied by anxiety, depression, unpredictability, and distress. The emotional effect of a cancer diagnosis and the rigidity of cancer treatment negatively impact the quality of life (QoL) of patients, and this may continue after treatment. Additionally, emotional distress induces neuroendocrine stress activation systems and raises stress hormone secretion by causing immunological dysfunctions. The present narrative review aims to describe nursing coaching approaches that improve QoL perceptions among cancer patients during their hospitalization.

Methods: This review was carried out using the PRISMA methodology until the end of November 2023 through PubMed, Scopus, Web of Science, and CINAHL databases. Researchers systematically collected all the currently available literature. The search terms and boolean operators used to combine keywords were: "QoL" AND "hospitalization" AND "cancer patients" AND "nursing coaching".

Results: Four manuscripts were selected in the present review. One manuscript belonged to the British Nursing Database and was a mixed-block-randomized study; one belonged to Scopus, which was also in the PubMed, WoS, and Medline and was a study protocol for an RCT and two manuscripts belonged to the PubMed database and were all RCTs.

Conclusion: Nursing coaching improved QoL perceptions in cancer patients during their hospitalization. Patients were found to prefer in-person interventions to nurse-led ones, which improved QoL perceptions. However, further interventional studies need to be performed in order to better address coaching nursing interventions during the hospitalization of cancer patients.

Introduction: Adrenal tuberculosis remains the main cause of primary adrenal insufficiency (PAI) in tuberculosis (TB)-prevalent regions. This case report details the presentation of PAI due to adrenal TB, where the etiological diagnosis involves Abdominal Computed Tomography (CT).

Case report: A 37-year-old Peruvian woman with a history of TB contact displayed symptoms of adrenal insufficiency. PAI diagnosis was established, and CT imaging unveiled bilateral adrenal enlargement with calcifications. Treatment with prednisone and anti-TB therapy led to symptomatic improvement. Unfortunately, she succumbed to pneumonia after ten months of follow-up.

Discussion: Adrenal TB must be considered in endemic regions and in the presence of a TB history. CT serves as a valuable diagnostic tool, particularly in settings with limited resources, revealing adrenal enlargement and calcifications.

Conclusion: In patients with PAI, epidemiological history of TB, and when a rapid biopsy is not feasible, CT proves to be a valuable diagnostic method.

Adenomas of the pituitary gland, predominantly prolactinomas, can exhibit aggressive behavior. Aggressive prolactinomas are characterized by radiographic invasion, rapid growth, clinically significant progression despite standard therapies, and recurrence after surgery or radiotherapy. Pituitary carcinoma is rare (0.1-0.2% of pituitary tumors) [1, 2]. Case Presentation: In 2005, a 50-year-old man presented with bitemporal hemianopsia and severe asthenia due to a large pituitary tumor. Hormonal tests revealed hyperprolactinemia and panhypopituitarism; he received hormonal replacement and dopamine agonists (DA) therapy with a reduction in prolactin levels. Ten years later, he experienced tumor regrowth consistent with pituitary apoplexy and VI cranial nerve palsy. MRI showed a macroadenoma with suprasellar extension and compression of the optic structures. The patient underwent transsphenoidal surgery in view of the partially resistant disease. Histopathology showed a pituitary macroadenoma, and immunohistochemistry showed a high mitotic index (Ki-67 80%). In 2016, the patient developed a partial deficit of the left sixth cranial nerve. He underwent a new surgery but with incomplete resection. In view of the aggressive and resistant nature of the disease, he received radiotherapy. In 2020, prolactin levels began to increase again. MRI showed an occipital- temporal lesion. Subsequently, he underwent radiotherapy and started chemotherapy with temozolomide, resulting in the normalization of prolactin levels in the absence of DA therapy. The patient is currently in remission, with no evidence of tumor recurrence. Conclusion: It was found that 15% of prolactinomas are resistant to DAs, and resistance to DA may signal malignant transformation. Therefore, multimodality therapy and molecular analysis are critical for aggressive prolactinomas and pituitary carcinoma.

Aim: The study aimed to compare the predictive capabilities of the traditional anthropometric indices with the novel anthropometric indices for incident hypertension.

Background: Some novel anthropometric indices, e.g., the Body Roundness Index (BRI) and A Body Shape Index (ABSI) have been associated with prevalent hypertension. There are a few cohort studies that have examined the association of the novel anthropometric indices with newonset hypertension in young adults.

Methods: This study included 2,448 military male and female young adults, aged 18-39 years, free of hypertension at baseline in Taiwan; they were followed for incidence of hypertension from 2014 till the end of 2020. Blood Pressure (BP) in mmHg was measured twice and averaged to verify hypertension, which was defined as systolic BP ≥130 and/or diastolic BP ≥80 or on antihypertensive medication therapy in each annual health examination. Anthropometric indices included the Body Mass Index (BMI) defined as the weight (kg)/height squared (m2), Waist Girth (WC) in cm, the Waist-to-height Ratio (WHtR), the BRI defined as 364.2 - 365.5 × {1 - [(WC/2π)/(0.5 × height)]2}0.5, as well as ABSI defined as WC/(BMI2/3 × height1/2). Multiple Cox regression analysis and Area Under the Curve (AUC) of the Receiver of Operating Characteristics (ROC) were utilized with adjustments for the baseline potential covariates to determine the association and compare the performance of various indices for incident hypertension.

Results: During a median follow-up period of 6.0 years, 920 new-onset hypertension cases (37.6%) developed. Higher BMI, WC, BRI (per each 1-unit increase) and WHtR (per each 0.1- unit increase) were associated with a greater risk of new-onset hypertension [Hazard Ratios (HRs) and 95% confidence intervals: 1.060 (1.035-1.085), 1.021 (1.011-1.030), and 1.178 (1.077-1.288), respectively], whereas there was no association between ABSI and new-onset hypertension. For the ROC, WC was observed with the greatest AUC for incident new-onset hypertension [0.661 (0.638-0.683)], followed by BMI [0.650 (0.628-0.673)], while the ABSI was found with the lowest AUC [0.544 (0.521-0.568)].

Conclusion: Most of the anthropometric indices were associated with a higher risk of new-onset hypertension among young adults, except for ABSI. In addition, this study has suggested the traditional indices, such as WC and BMI, to be superior to the latest ones, e.g., BRI and ABSI, for the prediction of new-onset hypertension.

Background: Autolοgous Hematopoietic Stem Cell Transplantation (AHSCT) is a treatment οption fοr patients with hematological malignancies that improves prοgnοsis and survival. Thus, it is necessary tο deal with its long-term cοmplications, such as sexual dysfunction and trauma that significantly affect survivors' quality οf life.

Objective: The aim οf this study was to evaluate the Sexual Function (SF) and the Pοst-traumatic Stress Disorder (PTSD) οf survivοrs οf hematolοgical malignancy and AHSCT.

Methods: A multicenter, quantitative, crοss-sectional, descriptive, and cοrrelational study was cοnducted from December 2019 to March 2022. Thrοugh cοnvenience sampling, 127 adults and sexually active survivors οf hematolοgic malignancy whο underwent AHSCT frοm 6 mοnths tο 5 years were recruited frοm 5 hοspitals in Athens. The survivοrs cοmpleted questionnaires on demοgraphic and clinical data, a male or female SF assessment tοοl [Internatiοnal Index Erectile Functiοn (IIEF) and Female Sexual Functiοn Index (FSFI), respectively], and the Impact of Event Scale-Revised (IES-R).

Results: Patients' mean age was 45.6 (±12.8) years. The median time frοm transplant was 3 years and the majοrity οf the survivοrs had Hodgkin's lymphοma. Accοrding tο the FSFI, wοmen had a mοderate level of SF, with a better functional area the "pain" and wοrse the "οrgasm". Accοrding tο the IIEF, men had a high level of SF, with a better functional area the "erection" and wοrse the "οverall satisfaction". Survivοrs had lοw levels οf PTSD based οn the IES-R, with nο differences between men and women. The subscale οf "hyperarοusal" had the lοwest values and the subscale οf "avοidance" had the highest values fοr bοth men and wοmen survivοrs. There was a lοw tο mοderate negative statistically significant cοrrelation between the IES-R and bοth FSFI and IIEF, suggesting a high level οf PTSD to be correlated with wοrse sexual function.

Conclusion: Survivοrs οf AHSCT had impaired SF tο varying degrees and areas of functionality depending οn their gender, but lοw levels of PTSD and lοw correlations between these twο variables. This matter is impοrtant in survivοrship care and needs further investigatiοn.

Background: Cushing's syndrome due to ectopic ACTH secretion is a rare clinical condition resulting from a dysregulatedACTH secretion by neuroendocrine tumors. The overall incidence of endogenous Cushing's syndrome is 0.7-2.4 per million peopleannually, with children accounting for only 10% of new cases each year.

Case report: When the patient first presented clinically, she was a 17-year-old girl who displayed psychiatric symptoms. Blood testsshowed diabetes mellitus and hypokalemia. She had hypertension and vertebral collapses. The hormone assay showed hypercortisolism,and because of this, she began taking metyrapone. The results of the 68Ga-PET/DOTATOC and 18FDG-PET scans were negative.The clinical course was intermittent. After one year, a 68Ga-PET/DOTATOC showed a nodule in the thymic lodge. Despite thethymectomy, the hypercortisolism persisted. A subsequent 68Ga-PET/DOTATOC repeated three months after surgery revealed anuptake corresponding to the thymic lodge. She underwent another surgery, which is finally being resolved. ACTH levels were monitoredbefore, during, and post-surgery. The laboratory provided the ACTH results promptly, and thoracic surgeons waited for hormonalresults before concluding the procedure. The adopted strategy permitted us to monitor the surgery outcome.

Conclusion: The heterogeneity of ectopic Cushing's syndrome makes diagnosis difficult. 68Ga-PET/DOTATOC proves to be a tracerwith good sensitivity and specificity for the identification of ACTH-secreting neuroendocrine lesions. The short half-life of ACTH isfound to be a strategy to monitor the complete surgical resection of the neuroendocrine lesion.

Introduction: We present an unusual case of a 28-year-old rheumatologic male patient who developed eosinophilia while he was on etanercept therapy first and then on golimumab.

Case representation: Although eosinophilia is rarely reported in the literature as a side-effect of various Tumor Necrosis Factor-alpha [TNF-alpha] antagonists, it represents a riddle about the future treatments of these patients since the persistence of therapy might lead to the onset of dermatologic or visceral eosinophilic complications in such patients.

Conclusion: Furthermore, the pathogenesis of eosinophilia is still unknown, and all the proposed hypotheses do not explain the eosinophilic proliferation in certain subjects.