Gender effects on cardiac valvular function in hyperprolactinaemic patients receiving cabergoline: a retrospective study

Background Ergot‐derived dopamine agonists are associated with increased risk of valvular dysfunction in Parkinson’s disease. The risk of valvular disease associated with lower doses of cabergoline used to treat prolactinomas remains controversial. Objective To determine whether there is an association of cabergoline and valvular function in patients with hyperprolactinaemia according to gender. Design Case‐record retrospective study. Setting Outpatient neuroendocrine clinical centre at a tertiary care hospital. Study participants One hundred patients (48 men and 52 women) with hyperprolactinaemia who had an echocardiogram while receiving cabergoline for at least 6 months. Controls One hundred controls (48 men and 52 women) selected from Massachusetts general hospital (MGH) database of echocardiograms without clinically significant findings, matched to patients for age, gender, body mass index (BMI) and hypertension. Main outcome measure Echocardiogram. Results There were no significant differences in valvular function in patients compared with controls. However, women patients had a higher prevalence of mild tricuspid regurgitation (TR) than female controls (15·4%vs. 1·9%, P = 0.03). Among men only, patients had more trace TR than controls (68·8%vs. 45·8%, P = 0.02). The mild valvular regurgitation in patients was not clinically significant and did not correlate with dose, duration or cumulative dose. Conclusions Overall cabergoline was not associated with valvulopathy. However, subdivided by gender, hyperprolactinaemic men and women had higher prevalence of trace or mild TR, respectively, compared with gender matched controls. There may be gender differences in valvular dysfunction associated with cabergoline. Longer term, larger studies are necessary to evaluate definitively an effect of cabergoline on valvular function in hyperprolactinaemic patients.     

Insulin-like factor 3 as a marker of testicular function in obese men

Objectives  Testicular function declines with obesity as a result of central and peripheral mechanisms, including a primary dysfunction of the Leydig cells. The levels of insulin-like factor 3 (INSL3), a sensitive marker of Leydig cell impairment, have never been evaluated in obese men. To better evaluate the hormonal function of the testis in obese men, we analysed their INSL3 plasma levels and compared them with the obesity status and the other reproductive hormones.
Design  Cross-sectional study.
Patients  Thirty-one obese men [body mass index (BMI) >30 kg/m²) aged 22–49 years and 64 age-matched nonobese men.
Measurements  Plasma concentrations of INSL3, testosterone (T), sex hormone-binding globulin (SHBG), oestradiol (E₂), LH, FSH. Free testosterone (FT) levels were calculated.
Results  Obese men had significantly lower plasma concentrations of total T, SHBG, FT and INSL3, and higher levels of E₂ with respect to nonobese men. LH and FSH values were not different from controls. In obese men, we found a significant negative correlation between BMI and INSL3, and a positive correlation between INSL3 and T. Only one (1/31, 3·2%) obese man had subnormal T levels. On the contrary, 10/31 (32·3%) obese men had low INSL3 values.
Conclusions  This study showed for the first time that INSL3 levels decrease with obesity, probably as a result of a primary dysfunction of the Leydig cells. INSL3 is a reliable marker of Leydig cell general impairment, whereas T mainly reflects the steroidogenic activity of these cells.     

Making sense of epidemiological studies of young children exposed to thimerosal in vaccines

ObjectiveTo compare epidemiological studies dealing with neurological issues (compatible with Hg toxicity) linked to exposing newborns and infants to intramuscular doses of preservative-Hg resulting from vaccination with thimerosal-containing vaccines (TCV).MethodsMajor databases were searched for studies that addressed neurodevelopment outcomes other than autism. Eight studies were identified and compared.ResultsInformation extracted from the studies done in the USA, the UK, and Italy is important in understanding the complex interplay of variables but insufficient to establish non-toxicity for infants and young children still receiving TCV: a) there is ambiguity in some studies reporting neurodevelopment outcomes that seem to depend on confounding variables; b) the risk of neurotoxicity due to low doses of thimerosal is plausible at least for susceptible infants; c) there is a need to address these issues in less developed countries still using TCV in pregnant mothers, newborns, and young children.ConclusionsSince the use of TCV is still inevitable in many countries, this increases the need to protect vulnerable infants and promote actions that strengthen neurodevelopment. Developing countries should intensify campaigns that include breastfeeding among efforts to help prime the central nervous system to tolerate exposure to neurotoxic substances, especially thimerosal-Hg.     

Attention to novelty in behaviorally inhibited adolescents moderates risk for anxiety

Background:  Individual differences in specific components of attention contribute to behavioral reactivity and regulation. Children with the temperament of behavioral inhibition (BI) provide a good context for considering the manner in which certain components of attention shape behavior. Infants and children characterized as behaviorally inhibited manifest signs of heightened orienting to novelty. The current study considers whether this attention profile moderates risk for clinical anxiety disorders among adolescents with a history of BI.
Methods:  Participants were assessed at multiple time points for BI, beginning in early childhood. At adolescence, event-related potentials (ERPs) were recorded during a three-stimulus auditory novelty oddball task, which employed frequent standard and infrequent deviant tones as well as a set of complex, novel sounds. Clinical diagnosis was carried out using the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL). P3 and mismatch negativity (MMN) components were examined at midline frontal, central, and parietal electrode sites.
Results:  Individuals who displayed high levels of BI during childhood and increased P3 amplitude to novelty in adolescence were more likely to have a history of anxiety disorders compared to behaviorally inhibited adolescents with lower P3 amplitudes. Groups did not differ on measures of MMN.
Conclusions:  Increased neural responses to novelty moderate risk for anxiety disorders amongst individuals with a history of BI.     

Clinical assessment of a group of children with juvenile rheumatoid arthritis receiving long-term treatment with oral gold salt]

The authors assess the efficacy of gold salt treatment for juvenile rheumatoid arthritis. The study was carried out on 16 children suffering from mono-pauciarticular, polyarticular and systemic arthritis. Treatment consisted of the administration of auranofin alone in a group of 8 children and auranofin associated to corticosteroids in a second group of 8 children. A marked improvement in clinical conditions was observed with slight transitory side effects at follow-up after 12 and 24 months.     

Zinc and nociception: a pharmacological approach

In the last decade, neurophysiological research regarding nociceptive mediation seems to suggest a possible new approach in pain management--zinc applicability. Immunohistochemical studies prove that zinc can be found in central nervous system, inside structures active in nociception. Zinc stabilizes primary afferent C fibers, nervous fibers involved in nociception. However, this phenomenon is probably only true for extreme zinc concentrations--excess or deficit. Electrophysiological studies indicate that zinc inhibits NMDA receptors, while potentiating the activity of non-NMDA receptors. All these are arguments supporting the existence of a role of endogenous zinc regarding pain transmission.