Effect of maternal asthma,inhaled glucocorticoids and cigarette use during pregnancy on the newborn insulin-like growth factor axis

BackgroundFetal growth varies in a sex-specific manner in response to maternal asthma during pregnancy, but the mechanisms are unclear.ObjectiveWe examined the influence of maternal asthma severity and associated exposures, inhaled glucocorticoid treatment, maternal cigarette use, and fetal sex on fetal growth and placental function during pregnancy and on the newborn insulin-like growth factor (IGF) axis.Study subjects and designFetal growth was assessed in a prospective cohort of asthmatic and non-asthmatic women (n = 145). At delivery, umbilical vein plasma was collected from male (n = 61, controls n = 16 and asthmatic n = 45) or female (n = 84, controls n = 22 and asthmatic n = 62) fetuses. Cord plasma insulin-like growth factor (IGF) binding protein (BP)-1, IGFBP-3, IGF-1 and IGF-2 were measured by radioimmunoassay and ELISA.ResultsCord plasma IGF-1 was the main component of the neonatal IGF axis altered by asthma and cigarette use. IGF-1 was increased in the presence of mild asthma and a male fetus and decreased in the presence of a female fetus and maternal asthma with cigarette use. IGFBP-3 was also decreased in the female fetuses of pregnancies complicated by asthma and cigarette use. Inhaled glucocorticoid use for the treatment of asthma did not affect the IGF axis. The strongest overall predictor of female birth weight after accounting for asthma severity, inhaled glucocorticoid treatment and cigarette use was IGF-1. For males, the strongest predictor of birth weight was IGFBP-3.ConclusionThe data suggest male and female fetuses institute different strategies in response to adverse pregnancy conditions such as asthma and cigarette use.     

Causes of secondary hypertension in the young population: A monocentric study

ObjectiveTo study the prevalence of different causes of hypertension in young adults referred to a hypertension center in the south west of France.MethodsWe conducted a retrospective overview of patients younger than 40 years old hospitalized consecutively in the Hypertension department of Toulouse University Hospital between 2012 and 2014. Clinical data about gender, age, anthropomorphic parameters and blood pressure measurement by 24 h Ambulatory Blood Pressure Monitoring (ABPM) were recorded. Biological data concerned dosages of kalemia, renin and aldosterone in the supine or after 15 min of seating. Recorded radiological examinations were renal artery ultrasound and abdominal CT scan.ResultsOne hundred and forty-eight detailed medical records were analyzed, 69 women and 79 men. Among the 69 women, the causes of secondary hypertension were primary aldosteronism (n = 7), fibromuscular dysplasia (n = 5) and renal disease (n = 4). Oral contraceptives were involved in 13 women. In addition, essential hypertension concerned 40 women (58%). Among the 79 men, the causes of secondary hypertension were primary aldosteronism (n = 10), fibromuscular dysplasia (n = 3), left main renal artery entrapment by a diaphragmatic crura (n = 2), renal disease (n = 1), pheochromocytoma (n = 3) and coarctation of the aorta (n = 2). In addition, essential hypertension concerned 58 men (73%).ConclusionsIn our population, the prevalence of secondary hypertension is close to 33% (42% of females and 27% of males), with the following main causes: primary aldosteronism for 11.5%; fibromuscular dysplasia for 5.4%. Oral contraceptives were involved in the hypertension of 19% of the females.     

Influence of steatosis on progression of fibrosis and virological response in chronic hepatitis C cases

Background and study aimsHepatic steatosis seems to be frequently found histopathologically in chronic hepatitis C virus (HCV)-infected patients. The aim of this study is to determine the influence of steatosis on HCV disease severity (fibrosis) and to evaluate its impact on sustained virological response (SVR) to antiviral therapy.Patients and methodsFrom April 2008 to April 2010, 148 consecutive adults (87 females (59%) and 61 males (41%); mean age: 55.2 years) with HCV admitted for liver biopsy were included in this retrospective study. At least one element of metabolic syndrome was identified in all cases: Obesity (n = 44), hyperlipidaemia (n = 40), hypertension (n = 29) and diabetes (n = 21). Liver fibrosis was classified according to the Metavir score and hepatic steatosis described as following: S0: absent; S1: minimal (<30%); S2: moderate (30–60%); and S3: severe (>60%). Patients were divided into two groups: S0S1 group (absent or minimal steatosis) and S2S3 group (moderate to severe steatosis). Of the 148 patients, 53 were treated with pegylated interferon and ribavirin combination therapy.ResultsSteatosis was found in 40 patients (27%): S1 in 72.5%, S2 in 17.5% and S3 in 10% of cases. The distribution of patients according to the degree of fibrosis was as follows: in the S0S1 group, F1 = 12.4%, F2 = 36.5%, F3 = 21.1% and F4 = 21.1% and in the S2S3 group, F1 = 9%, F2 = 45.5%, F3 = 18.2% and F4 = 27.3%. There was no difference between the two groups regarding the degree of fibrosis (p ? 0.80). The rate of SVR was 64%: 63% in the S0S1 group and 75% in the S2S3 group. The difference was not statistically significant (p = 1).ConclusionSteatosis was found in 25% of cases. Liver steatosis in chronic hepatitis C is not a negative prognostic factor of response to combined antiviral therapy. These results must be confirmed by a large series of patients.     

Niveles séricos de IGF-1 e IGFBP-3 en pacientes con esófago de Barrett y adenocarcinoma de esófago. Estudio longitudinal

BackgroundBarrett's esophagus (BE) is an entity with a known histological progression to malignancy. The insulin-like growth factor (IGF) system is involved in the carcinogenesis through obesity-related mechanisms that include IGF and it has been associated with several types of cancer.ObjectivesTo evaluate the serological levels of IGF-1 and IGFBP-3 in patients with BE and esophageal adenocarcinoma.Patients and methodsProspective study of patients with BE and esophageal adenocarcinoma who underwent upper endoscopy between September 2012 and December 2015. A baseline determination of IGF-1 and IGFBP-3 was performed. We included a control group of patients without BE.ResultsOne hundred sixteen patients were included: 36 controls, 62 with BE (42 without dysplasia and 20 with dysplasia) and 18 with adenocarcinoma. IGF-1 and IGF-1/IGFBP-3 molar ratio showed a progression to high levels in BE and adenocarcinoma than in controls (IGF-1: 135.55 ± 66.07 ng/ml, 148.33 ± 81.5 ng/ml, 108.19 ± 46.69 ng/ml, respectively; P = .049) (molar ratio: 0.23 ± 0.91, 0.29 ± 0.11, 0.19 ± 0.06, respectively; P = .001), without differences between the histological types of BE. Fifty-four out of the 65 patients with BE were followed up (median of 58.50 months, range 12–113) and 11 of them (20.4%) presented progression to low-grade dysplasia (n = 8) or high-grade dysplasia/adenocarcinoma (n = 3), without differences in the IGF system compared with patients without progression.ConclusionsPatients with BE and esophageal adenocarcinoma have changes in the IGF system although the serological levels of IGF-1 and IGFBP-3 do not correlate with histological progression of BE.     

Whey protein supplementation in nursing home residents. A randomized controlled trial

PurposeThe effects of supplementation with whey proteins high in leucine content were tested in older nursing home residents.Materials and methodsResident of a municipal nursing home (n = 106) were recruited to this 6-month randomized controlled trial. Both the test (n = 49) and control group (n = 57) received 1.5 deciliters of juice three times a day. The test juice was fortified with whey protein fractions (20 g/d: 75% β-lactoglobulin, 25% α-lactalbumin). The responses of muscle mass (bioimpedance spectroscopy), strength (hand grip, knee extension) and physical performance (walking, toileting) were measured. In addition to blood samples, data from comprehensive geriatric assessment were collected.ResultsWhey supplementation resulted in 2.1% increase in body weight, in contrast to 1.9% weight loss in the control group (P = 0.001). The skeletal muscle index decreased in the control group (P = 0.028), resulting in mean difference of 10.3% between groups (P = 0.039) during the first 3 months, but this difference leveled off at 6 months. The responses in muscle strength were similar, but patients on whey protein needed less physical assistance after 6 months. Insulin like growth factor 1 (IGF-1) and insulin increased in the test group, in which patients experienced less often infections, skin ulcers, and worsening of discomfort behavior.ConclusionSupplementation with whey protein fractions increases body weight and activates the IGF-1 axis in typical nursing home residents in Finland. Supplementation seems to also associate with maintenance of skeletal muscle mass, reduction in required physical assistance and general well being. However, larger well-designed trials are needed to confirm these associations.     

Analysis of the relationship of insulin-like growth factor-1 to the growth velocity and feeding of healthy infants

ContextInfancy is the fastest growth period in a child's development after birth, but little is known about hormonal regulation mechanism for the growth and development of this period.ObjectiveThe objective of this study is to analyze the trend of serum IGF-1 levels in healthy infants and the relationship of IGF-1 to the growth velocity and feeding method of infants.DesignPopulation-based birth cohort study.SettingThe study was conducted in the Third Hospital of Peking University.ParticipantsStudy participants were 484 healthy infants, all of whom were full-term and appropriate for gestational age (238 boys and 246 girls).InterventionsInterventions were anthropometrical measurements, feeding methods recorded every 1 to 2 months and serum samples (2, 4, 6, 8, 10,12 months).Main outcome measuresHeight, weight, feeding methods and serum IGF-1 were the main outcome measures.ResultsSerum IGF-1 levels decreased in the following 2 months in boys but in females levels remained relatively high between 2 to 3 months after birth and then started to decrease. It reached the lowest point at Months 7–8, and was on a slow rise in both male infants and female infants thereafter. Serum IGF-1 levels were significantly higher in female infants [112.65 ng/ml (CI 91.82, 133.89)] than in male infants [74.38 ng/ml (CI 53.14, 95.61)] at early infancy. Infants fed with human milk had lower serum IGF-1 levels than infants fed with formula milk or human milk plus formula milk (66.94 ± 45.85 ng/ml, 72.56 ± 36.55 ng/ml, 79.89 ± 51.79 ng/ml, respectively; P = 0.019). IGF-1 levels were positively correlated to the growth velocity of body length (P < 0.01).ConclusionThis study provides the trend for IGF-1 levels at infancy. It is highly possible that IGF-1 plays an important role in the regulation and control of length increases in infants, and feeding method influences serum IGF-1 levels.     

Similar prevalence,different spectrum: IgE-mediated food allergy among Turkish adolescents

BackgroundScarcity of reliable data on food allergy prevalence exists in Turkey. We aimed to assess reported and confirmed IgE-mediated food allergy prevalence, and define the spectrum of allergenic food.MethodsWe prospectively evaluated the ISAAC Phase II study population for food allergy. Participants that reported experiencing food allergy symptom in the last year and/or were skin prick test positive for a predefined list of food allergens, were interviewed via telephone, and those considered as having food allergy were invited to undergo clinical investigation, including challenge tests.ResultsA total of 6963 questionnaires were available. Parental reported food allergy prevalence and skin prick sensitisation rate were 20.2 ± 0.9% and 5.9 ± 0.6%. According to the above-defined criteria, 1162 children (symptom positive n = 909, skin prick test positive n = 301, both positive n = 48) were selected and 813 (70.0%) were interviewed via telephone. Out of 152 adolescents reporting a current complaint, 87 accepted clinical investigation. There were 12 food allergies diagnosed in nine adolescents, with food allergy prevalence of 0.16 ± 0.11%. The most common foods involved in allergic reactions were walnut (n = 3) and beef meat (n = 2), followed by hen's egg (n = 1), peanut (n = 1), spinach (n = 1), kiwi (n = 1), cheese (n = 1), hazelnut (n = 1) and peach (n = 1).ConclusionsWhile parental reported food allergy prevalence was within the range reported previously, confirmed IgE-mediated food allergy prevalence among adolescents was at least 0.16%, and the spectrum of foods involved in allergy differed from Western countries, implying environmental factors may play a role.     

IGF-1 alters the human parietal pleural electrochemical profile by inhibiting ion trans-cellular transportation after interaction with its receptor

ObjectiveThe effect of IGF-1 in the human pleural permeability and the underlying mechanisms involved were investigated.DesignSpecimens from thoracic surgical patients were mounted in Ussing chambers. Solutions containing IGF-1 (1 nM–100 nM) and IGF-1 Receptor Inhibitor (1 μΜ), amiloride 10 μM (Na⁺ channel blocker) and ouabain 1 mM (Na⁺–K⁺ pump inhibitor) were used in order to investigate receptor and ion transporter involvement respectively. Trans-mesothelial Resistance (R_TM) across the pleural membrane was determined as a permeability indicator. Immunohistochemistry for IGF-1 receptors was performed.ResultsIGF-1 increased R_TM when added on the interstitial surface for all concentrations (p = .008, 1 nM–100 nM) and decreased it on the mesothelial surface for higher concentrations (p = .046, 100 nM). Amiloride and ouabain inhibited this effect. The IGF-1 Receptor Inhibitor also totally inhibited this effect. Immonuhistochemistry demonstrated the presence of IGF-1 receptors in the pleura.ConclusionsIt is concluded that IGF-1 changes the electrophysiology of the human parietal pleura by hindering the normal ion transportation and therefore the pleural fluid recycling process. This event is achieved after IGF-1 interaction with its receptor which is present in the human pleura.     

Trends from 1995 to 2006 in the prevalence of self-reported cardiovascular risk factors among elderly Spanish diabetics

AimIn this study, we examined the trends from 1995 to 2006 in cardiovascular risk factors (CVRF) in Spaniards aged 65 years or older with diabetes.MethodsWe looked at the individual data from adults aged ≥ 65 years from the Spanish National Health Surveys of 1995 (n = 1117), 1997 (n = 1111), 2001 (n = 4328), 2003 (n = 6134) and 2006 (n = 7835). Those classified as having diabetes had answered the two following questions in the affirmative: Has your doctor told you that you currently have diabetes? Have you taken any medication to treat diabetes in the last two weeks? The CVRF of interest included high blood pressure (HBP), high cholesterol levels, obesity (BMI ≥ 30 kg/m²), smoking and sedentarity, which were estimated and compared for prevalence by survey year, age group and gender. Progression over time was analyzed using logistic-regression models.ResultsDuring the study period, the prevalences of all of the CVRF of interest were significantly higher among the elderly with diabetes compared with those without diabetes, except for current smoking, which was less frequent. The percentages of diabetic patients with HBP and obesity increased from 49.6 and 17.1%, respectively, in 1995 to 64 and 30.6%, respectively, in 2006 (adjusted ORs: 1.95 for HBP; 2.22 for obesity).ConclusionOverall, the self-reported prevalence of CVRF among elderly patients with diabetes did not improve during 1995–2006 but, instead, showed significant increases in self-reported obesity and HBP. This lack of improvement calls for further investigations, and the dedicated attention of both healthcare providers and the diabetic patients themselves.     

Central nervous system infection following allogeneic hematopoietic stem cell transplantation

Objective/backgroundHere, we described the clinical characteristics and outcomes of central nervous system (CNS) infections occurring after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in a single institution over the previous 6 years.MethodsCharts of 353 consecutive allogeneic transplant recipients were retrospectively reviewed for CNS infection.ResultsA total of 17 cases of CNS infection were identified at a median of 38 days (range, 10–1028 days) after allo-HSCT. Causative pathogens were human herpesvirus-6 (n = 6), enterococcus (n = 2), staphylococcus (n = 2), streptococcus (n = 2), varicella zoster virus (n = 1), cytomegalovirus (n = 1), John Cunningham virus (n = 1), adenovirus (n = 1), and Toxoplasma gondii (n = 1). The cumulative incidence of CNS infection was 4.1% at 1 year and 5.5% at 5 years.ConclusionMultivariate analysis revealed that high-risk disease status was a risk factor for developing CNS infection (p = .02), and that overall survival at 3 years after allo-HSCT was 33% in patients with CNS infection and 53% in those without CNS infection (p = .04).     

Determinants of plasma triglyceride levels in a multiethnic working class Caribbean population: Effect of ethnicity,diet and obesity

AimsObjective of the study is to identify the predictors of plasma triglycerides.Materials and methodsA stratified random sample of university staff categories underwent measurements of anthropometry, blood pressure, and fasting blood glucose, insulin, lipids, CRP and homocysteine. Dietary intakes were assessed using duplicate 24 h recalls. HOMA-IR was calculated. Stepwise, multivariate regression analysis was performed with TAG as the dependent variable.ResultsThe sample (n = 251) was 55% females with a mean age of 44.9 ± 9.7 years. African ancestry comprised 43%, followed South Asian 30% and mixed ethnicity 27%. Prevalence of obesity was 19.4%, insulin resistance 22.7% and metabolic syndrome 21.6%. Males had significantly higher (p < 0.01) triglycerides and VLDL and lower HDL than females. Africans had significantly lower triglycerides and cholesterol than South Asians and Mix. Triglycerides were significantly (p < 0.01) correlated with glucose, cholesterol, insulin, CRP, systolic, diastolic blood pressure, WC, BMI, age and components of MS. Glucose, cholesterol, insulin and total energy intake predicted TAG, to varying extents, in all participants (R² = 45.1%), males (R² = 40.3%), females (R² = 56.0%), Africans (R² = 35.0%), TSA (R² = 31.5%) and mix (R² = 51.0%).ConclusionsAfricans have lower triglycerides and cholesterol than South Asians and mix. Major predictors of triglycerides were fasting glucose and cholesterol independent of gender and ethnicity.     

The prevalence of adverse events associated with double-balloon enteroscopy from a single-centre dataset in Japan

BackgroundThere are few comprehensive reports detailing the prevalence of major adverse events associated with a double-balloon enteroscopy procedure.MethodsWe retrospectively investigated the prevalence of major adverse events in 538 patients (262 males and 276 females; median age, 65 years; age range, 12–95 years) who underwent double-balloon enteroscopy at our Institution between April 2008 and October 2011.ResultsOf the 17 adverse events recorded (3.2%), acute pancreatitis (n = 5; 0.9%) occurred during both diagnostic (n = 3) and therapeutic (n = 2) anterograde double-balloon enteroscopy, and all of them were treated conservatively. For these cases, the average duration of the examination was 135 min, which was longer than for the other patients (97 min) (P = 0.046). Intestinal bleeding (1.3%) was observed in 6 cases after endoscopic polypectomy and in 1 case following a biopsy procedure during a diagnostic double-balloon enteroscopy. The prevalence rates of intestinal perforation and other complications were 0.2% and 0.7%, respectively.ConclusionsThe rate of adverse events associated with double-balloon enteroscopy was high compared to that associated with conventional upper/lower gastrointestinal endoscopy (0.042%/0.078%). The occurrence of acute pancreatitis may be significantly dependent on the duration of double-balloon enteroscopy examination.     

Colonoscopic perforations in inflammatory bowel disease: A retrospective study in a French referral centre

BackgroundWhether inflammatory bowel disease patients are at increased risk of colonoscopic perforations remains controversial. Aim of this study was to investigate whether these patients are at increased risk of perforations.MethodsElectronic charts of all patients enrolled in the Nancy IBD cohort (1999–2012) were reviewed. All non-inflammatory bowel disease patients who underwent colonoscopy (1999–2012) were used as controls.ResultsOf 17,992 colonoscopies, 2375 (13.2%) were performed for inflammatory bowel disease: 1547 for Crohn's disease and 828 for ulcerative colitis. Four IBD patients (0.168%) experienced perforation. Perforation occurred in the sigmoid colon (n = 3) and right colon (n = 1) during disease monitoring or colonic stenosis dilatation. Three patients underwent surgery (2 stomas and no death). Colonoscopic perforation occurred in 16/15,617 controls (0.102%): colonic cancer diagnosis (n = 5, 31.3%) or dilatation (n = 2, 12.5%), polypectomy (n = 5, 31.3%) or mucosectomy (n = 1, 6.3%), and follow-up after diverticulitis (n = 2, 12.5%). Perforation rate was not different between IBD and controls (p = 0.57). Perforations occurred in the sigmoid colon (n = 10, 62.5%), the right colon (n = 4, 25%) and the rectum (n = 2, 12.5%). Twelve controls underwent surgery (9 stomas and one death).ConclusionIn this referral centre-based cohort, inflammatory bowel disease patients were not at increased risk of colonoscopic perforation compared to non-IBD controls.     

Índice de masa corporal y eficacia y seguridad del ticagrelor frente al prasugrel en pacientes con síndrome coronario agudo

Introduction and objectivesThe efficacy and safety of ticagrelor vs prasugrel in patients with acute coronary syndromes (ACS) according to body mass index (BMI) remain unstudied. We assessed the efficacy and safety of ticagrelor vs prasugrel in patients with ACS according to BMI.MethodsPatients (n = 3987) were grouped into 3 categories: normal weight (BMI < 25 kg/m²; n = 1084), overweight (BMI ≥ 25 to < 30 kg/m²; n = 1890), and obesity (BMI ≥ 30 kg/m²; n = 1013). The primary efficacy endpoint was the 1 year incidence of all-cause death, myocardial infarction, or stroke. The secondary safety endpoint was the 1 year incidence of Bleeding Academic Research Consortium type 3 to 5 bleeding.ResultsThe primary endpoint occurred in 63 patients assigned to ticagrelor and 39 patients assigned to prasugrel in the normal weight group (11.7% vs 7.5%; HR, 1.62; 95%CI, 1.09-2.42; P = .018), 78 patients assigned to ticagrelor and 58 patients assigned to prasugrel in the overweight group (8.3% vs 6.2%; HR, 1.36; 95%CI, 0.97-1.91; P = .076), and 43 patients assigned to ticagrelor and 37 patients assigned to prasugrel in the obesity group (8.6% vs 7.3%; HR, 1.18; 95%CI, 0.76-1.84; P = .451). The 1-year incidence of bleeding events did not differ between ticagrelor and prasugrel in patients with normal weight (6.5% vs 6.6%; P = .990), overweight (5.6% vs 5.0%; P = .566) or obesity (4.4% vs 2.8%; P = .219). There was no significant treatment arm-by-BMI interaction regarding the primary endpoint (P_int = .578) or secondary endpoint (P_int = .596).ConclusionsIn patients with ACS, BMI did not significantly impact the treatment effect of ticagrelor vs prasugrel in terms of efficacy or safety.Clinical Trial Registration: NCT01944800.     

The significance of forearm bone mineral density evaluation in determining surgical indications in primary hyperparathyroidism

PurposeForearm osteoporosis is a well-known complication of primary hyperparathyroidism (PHPT). However, measuring forearm bone mineral density (BMD) by dual-energy X-ray absorptiometry (DXA) at the distal radius is often neglected in clinical practice despite the fact that osteoporosis at any site is a criterion indicating surgery. We aimed to evaluate the importance and priority of forearm BMD and to determine its association with biochemical parameters.Material and methodsThree hundred fourteen patients (272 females, 42 males) with PHPT who had BMD measurements at 3 sites were recruited for this retrospective study. The effect on surgical indications of osteoporosis only in the forearm was evaluated. Group 1 (n = 151) with forearm osteoporosis and group 2 (n = 163) without were compared in terms of biochemical and clinical parameters.ResultsIn the overall study population, 165 of the 314 patients had osteoporosis in at least 1 site. Twenty seven percent (n = 86/314) had osteoporosis only in the forearm, while the other 2 sites (lumbar spine and femoral neck) were normal or osteopenic. Surgery was indicated based on osteoporosis only in the forearm in 10% of patients (n = 30/314). Corrected calcium and parathyroid hormone levels were significantly higher in group 1 than group 2 (p = 0.001 and p < 0.001, respectively) and were also negatively correlated with distal radius BMD, T-score and Z-score in the whole study group.ConclusionIncluding the distal radius in BMD measurement increased the number of patients diagnosed with osteoporosis and for whom surgery was indicated. Calcium and PTH were also more frequently elevated in patients with forearm osteoporosis. These results show that distal radius BMD is relevant to the management of PHPT.     

Does good clinical practice at the primary care improve the outcome care for diabetic patients? Gender differences

BackgroundThe Middle East region is predicted to have one of the highest prevalence of diabetes mellitus (DM) in the world. This is the first study in the region to assess treatment outcome of DM according to gender.ObjectiveTo assess the quality and effectiveness of diabetes care provided to patients attending primary care settings according to gender in the State of Qatar.DesignIt is an observational cohort study.SettingThe survey was carried out in primary health care (PHC) centers in the State of Qatar.Subjects and methodsThe study was conducted from January 2010 to August 2010 among diabetic patients attending (PHC) centers. Of the 2334 registered with diagnosed diabetes, 1705 agreed and gave their consent to take part in this study, thus giving a response rate of 73.1%. Face to face interviews were conducted using a structured questionnaire including socio-demographic, clinical and satisfaction score of the patients.ResultsMajority of subjects were diagnosed with type 2 DM (84.9%). A significantly larger proportion of females with DM were divorced or widowed (9.1%) in comparison to males with DM (3.4%; p < 0.001). A significantly larger proportion of females were overweight (46.5%; p = 0.009) and obese (29.5%; p = 0.003) in comparison to males. Males reported significantly greater improvements in mean values of blood glucose (mmol/l) (?2.11 vs. ?0.66; p = 0.007), HbA1c (%) (?1.44 vs. ?0.25; p = 0.006), cholesterol (mmol/l) (?0.16 vs. 0.12; p = 0.053) and systolic blood pressure (mmHg) (?9.04 vs. ?6.62; p < 0.001) in comparison to females. While there was a remarkable increase in male patients with normal range of fasting blood glucose (FBG; 51.6%) as compared to the FBG measurement 1 year before (28.5%: p < 0.001) there was only a slight increase in females normal range FBG during this period from 28.0% to 30.4% (p = 0.357).ConclusionThe present study revealed that the current form of PHC centers afforded to diabetic patients provided significantly improved outcomes for males, but only minor improved outcomes for females. This study reinforces calls for a gender-specific approach to diabetes care.     

Pegvisomant treatment in acromegaly in clinical practice: Final results of the French ACROSTUDY (312 patients)

ObjectiveWe report the final analysis of the French ACROSTUDY, using data revised and enriched since the 2013 interim analysis. Our objective was to validate the use of pegvisomant (PEGV) in the treatment of acromegaly and to determine efficacy and safety.Patients and methodsPatients with acromegaly treated with PEGV and followed up for at least 5 years were included. Eighty-eight investigators from 62 clinical centers in France included patients from April 2007 to April 2014. PEGV dose and administration frequency were determined by the physicians, based on their clinical evaluation and local habits. No additional examinations beyond those performed in normal follow-up were required. Minimum recommended follow-up included check-ups at treatment initiation, 6 months, 12 months and then annually.ResultsIn total, 312 patients were enrolled. Mean age was 46.1 ± 14.3 years at introduction of PEGV. Median PEGV treatment duration was 6.3 years and median follow-up was 5.6 years. Median dose at initiation was 10 mg/day. The percentages of patients with IGF-1 ≤ ULN (upper limit of normal) were 10% (n = 300) at baseline, 54% at 6 months (n = 278), and 61.7% (n = 253) at 2 years, then stabilizing at 64.4% (n = 180) at 5 years. Mean PEGV dose was 17.4 ± 11.7 mg in patients with controlled disease versus 21.1 ± 17.3 mg in those without control at 5 years. At 5 years, 21.8% of patients (54/248) were receiving >30 mg PEGV per day. In patients with at least one pituitary imaging procedure during the 5-year follow-up (n = 292), the most recent image showed stable tumor volume in 212 subjects (72.6%), increased volume in 13 (4.5%), and decreased volume in 30 (10.3%). No PEGV treatments were permanently discontinued due to transaminase elevation. There were no cases of liver failure.ConclusionThe French ACROSTUDY showed normalization of IGF-1 levels in 64.4% of a real-life cohort of patients, mostly with uncontrolled disease despite multiple prior therapies. Long-term follow-up showed a sustained effectiveness and good long-term safety.     

Adipocytokine profiles as influenced by insulin resistance in obese subjects

ObjectiveThis study aims to explore the baseline adipocytokine profiles of adult Saudis and evaluate their relationship in the development of insulin resistance.MethodsIn this cross-sectional study, 300 adult Saudis with varying glucose tolerance were recruited. They were grouped into NGT, IGT and DM. Anthropometrics, glucose and lipid profiles were analyzed by routine methods; leptin, adiponectin, resistin and CRP were measured by ELISA.ResultsInsulin resistance was significantly correlated with levels of CRP (R = 0.32, p = 0.02) in the NGT; with leptin levels (R = 0.46, p = 0.001) in the IGT; and with adiponectin levels (R = 0.25, p = 0.001) in all groups. In males, resistin and CRP exhibited significant correlations to insulin resistance (R = 0.33, p = 0.005); in females significant correlation was demonstrated between insulin resistance and adiponectin (R = 0.32, p = 0.003). Significant associations exist in the adipocytokine profiles of adults with different glucose tolerance.ConclusionCertain adipocytokines can be used not only as promising markers but also as potential adjunct therapy with regards to insulin sensitivity and obesity.     

Are there any causes for increased thyroid volume in women with prolactinoma?

PurposeThe aim of this study was to evaluate thyroid volume in women with prolactinoma and investigate the relationship between anabolic hormones [insulin, insulin like growth factor (IGF-1), estrogen] and thyroid volume in the patients.Material-methodSixty-three euthyroid women with prolactinoma and 60 healthy euthyroid women were included. Serum prolactin (PRL), thyroid-stimulating hormone (TSH), thyroxine (free T4), free tri-iodothyronine (free T3), insulin resistance (IR) which was estimated by the homeostasis model assessment, thyroidal microsome (anti-TPO), antithyroglobulin antibodies (TgAb), estradiol (E2), and insulin like growth factor (IGF-1) were evaluated, and thyroid volume was calculated by B-mode doppler USG.ResultsThe mean thyroid volume was significantly higher in women with prolactinoma (82.5 ± 15.1 mL) than in healthy women (76 ± 15.1 mL)(P = 0.014), but no correlation was found between thyroid volume and serum PRL levels (P = 0.967). There were also no differences between thyroid volume, anabolic hormones (E2, IGF-1), and insulin resistance in women with prolactinoma (P = 0.776, P = 0.786, P = 0.647, respectively).ConclusionsOur study did not show an association between anabolic hormones and increased thyroid volume in women with prolactinoma.