Normal glucose values are associated with a lower risk of mortality in hospitalized patients

OBJECTIVE—Hyperglycemia is a common condition in hospitalized patients. The aim of this study was to investigate the relationships between glycemia upon admission and mortality in a heterogeneous group of adult patients.RESEARCH DESIGN AND METHODS—The 3-year records released from a general hospital were associated with a plasma glucose dataset of its general laboratory. A matched case-control study was implemented (3,338 case-control subject pairs). All-patient refined diagnosis–related groups and the relative risk of death were the matching criteria. A multivariate conditional logistic regression model was used to evaluate the associations between death and glycemia.RESULTS—Higher in-hospital mortality was associated with hyperglycemia or hypoglycemia, whereas lower risk was observed for values between 78 and 101 mg/dl.CONCLUSIONS—Our data confirm the relation between glycemia upon admission and mortality and suggest that slightly increased or decreased plasma glucose can be linked with increased mortality risk.Hyperglycemia is a common comorbid condition in hospitalized patients, independent of the diagnosis of diabetes, and is associated with adverse outcomes (1–4). Although there is strong evidence suggesting that tight glycemic control is intimately linked to an improved outcome in the intensive care unit (5), hyperglycemia in hospitalized patients is generally not considered a major therapeutic focus. It is important to determine target plasma glucose concentrations and glycemic thresholds associated with optimal benefits during hospitalization. The aim of this study was to investigate the relationship of plasma glucose on admission with in-hospital mortality and to identify the range of glycemic values associated with significant reductions of mortality risks in a heterogeneous group of hospitalized adult patients.     

Intrathyroidal Differentiated Thyroid Carcinoma: Tumor Size-Based Surgical Concepts

Introduction  Total thyroidectomy (TT) remains the treatment of choice for differentiated thyroid carcinomas (DTCs), but a limited approach can be proposed when tumors are at an early stage and limited to a single lobe. The aim of this study was to analyze the pathologic and clinical aspects of a retrospective series of DTCs in an attempt to determine whether these features might prove useful for limiting the surgical strategy in selected cases. Methods  From 2000 to 2005, a total of 2798 patients (637 males, 2161 females; mean age 44.6 years) underwent TT for papillary thyroid carcinoma in our department. The histologic features considered were size, histologic subtype and capsule of the tumor, its multifocality/bilaterality, infiltration of the thyroid capsule, and the presence of nodal metastases. Results  Statistical analysis revealed that among tumors ≤ 1 cm the presence of the tumor capsule, infiltration of the thyroid capsule, bilaterality, and the presence of node metastases were all significantly lower when the tumor size was ≤ 0.5 cm (p < 0.0001). Furthermore, patients with bilateral carcinomas demonstrated a significantly higher presence of a tumor capsule (p = 0.012), infiltration of the thyroid capsule (p < 0.0001), and node metastases (p < 0.0001) and a higher incidence of the “tall-cells” variant (p < 0.0001) when compared to the unilateral population. Conclusions  Based on these data it is suggested that tumors ≤ 1 cm cannot be considered a homogeneous class of DTCs. Nevertheless, in tumors ≤ 0.5 cm the absence of a “tall-cells” variant and the absence of infiltration of the thyroid capsule might be useful for avoiding an unnecessary completion thyroidectomy after lobectomy.     

Biological role and potential therapeutic targeting of the chemokine receptor CXCR4 in undifferentiated thyroid cancer

Anaplastic thyroid carcinoma (ATC) is a rare thyroid cancer type with an extremely poor prognosis. Despite appropriate treatment, which includes surgery, radiotherapy, and chemotherapy, this cancer is invariably fatal. CXCR4 is the receptor for the stromal cell-derived factor-1 (SDF-1)/CXCL12 chemokine and it is expressed in a variety of solid tumors, including papillary thyroid carcinoma. Here, we show that ATC cell lines overexpress CXCR4, both at the level of mRNA and protein. Furthermore, we found that CXCR4 was overexpressed in ATC clinical samples, with respect to normal thyroid tissues by real-time PCR and immunohistochemistry. Treatment of ATC cells with SDF-1 induced proliferation and increase in phosphorylation of extracellular signal-regulated kinases and protein kinase B/AKT. These effects were blocked by the specific CXCR4 antagonist AMD3100 and by CXCR4 RNA interference. Moreover, AMD3100 effectively reduced tumor growth in nude mice inoculated with different ATC cells. Thus, we suggest that CXCR4 targeting is a novel potential strategy in the treatment of human ATC.     

Physical,Mental and Sexual Health Among Transgender Women: A Comparative Study Among Operated Transgender and Cisgender Women in a National Tertiary Referral Network

BackgroundFew studies have investigated how physical, mental and sexual function are associated with each other in operated transgender women (oTW).AimTo provide information on the physical, mental and sexual health of oTW in comparison with a group of cisgender women (cisW).MethodsAn age-matched control study was carried out, recruiting 125 oTW in 7 national referral centers and 80 volunteer women. Beck Depression Inventory Primary Care (BDI-PC), General Health Survey (SF-36), Female Sexual Function Index (FSFI) and operated Male to Female Sexual Function Index (oMtFSI) questionnaires were web-based administered. Data included: age, area of origin, educational level, sexual orientation, years since surgery and hormone therapy.OutcomesT-test was applied to inspect mean score differences between oTW and cisW, in mental, sexual and physical health; simple correlations and multiple regression analysis revealed how mental, sexual and physical health were concurrently associated in the two groupsResultsResponse rate 60% (52% oTW, 71% cisW). oTW mean age 38.5 years (SD = 9.3), cisW 37.7 years (SD = 11.5). Both cisW and oTW reported average values in the range of mental, physical and sexual health. Statistical comparisons revealed no significant group differences in mental and physical health. oTW who referred a worse sexual function also reported worse overall mental well-being and higher levels of depressive symptoms. FSFI scores were negatively associated with years since surgery, but not with age. Multiple regression analysis showed that FSFI Pain accounted for a significant unique variance proportion of risk of depression in oTW. FSFI Sexual Pain was the strongest estimator of inter-individual differences in BDI-PC among oTW (P < .01).Clinical ImplicationsNo significant differences in the levels of depressive symptoms, physical and mental well- being were found in oTW and cis-W. The relation between depressive symptoms and sexual function in oTW is stronger than in cisW, and sexual pain substantially predicts risk of depression in oTW.Strengths & LimitationsThe evaluation of outcomes using validated questionnaires and the relatively large sample size. The convenience control group reported mental, physical and sexual health levels within the range of Italian normative data. Since this is a cross-sectional study, we must be careful in drawing conclusions from our results.ConclusionsSexual pain and lubrication difficulties are the main causes of worse sexual function in oTW, highlighting the importance of perioperative counseling to make surgical expectations realistic and to educate to a proper neovagina management.Vedovo F, Di Blas L, Aretusi F, et al. Physical, Mental and Sexual Health Among Transgender Women. A comparative Study Among Operated Transgender and Cisgender Women in a National Tertiary Referral Network. J Sex Med Rev 2021;18:982–989.     

Granulomatous anterior uveitis associated with bimatoprost

Purpose: To describe a previously unreported case of anterior granulomatous uveitis in a patient using bimatoprost. Methods: A 72-year-old woman with a long-standing history of anisometropic amblyopia and pseudoexfoliative glaucoma in the right eye started therapy with bimatoprost 0.03% once a day in the right eye. She had no previous history of ocular inflammation or ocular surgery. Her medical history was negative for systemic diseases associated with ocular inflammation. Results: After one week, the patient developed severe conjunctival injection, cells and flare, and numerous ‘mutton fat’ keratic precipitates in the right eye. Examination of the left eye revealed no evidence of inflammation. Bimatoprost was discontinued; no topical steroid therapy was started. Systemic investigations were normal. The inflammation resolved over two weeks, solely with the discontinuation of bimatoprost. Conclusions: Bimatoprost is a synthetic prostamide, chemically related to prostamide F. Prostamides are naturally occurring substances, biosynthesized from anandamide in a pathway that includes COX2. Even though anandamide has proven suggestive potential pro-inflammatory effects, the mechanism of induction of inflammation by bimatoprost remains uncertain and speculative. In our report, the onset of acute uveitis in a patient using bimatoprost, after a long-term and well-tolerated treatment with a prostaglandin analog, suggests a distinct potential pro-inflammatory action of prostamides. This can indirectly support the concept that the target receptor of bimatoprost is different, and that the mechanism of action of prostamides is pharmacologically unique.     

Polymicrobial Keratomycosis in a Three-Year-Old Child

Purpose: To describe a previously unreported case of polymicrobial mycotic keratitis caused by an association between Candida lusitaniae, C. parapsilosis, and Geotrichum candidum. Methods: A three-year-old child with an antecedent trauma with vegetable matter and a prolonged use of corticosteroid eyedrops developed fungal keratitis. Results: The isolates of the corneal scraping using Sabaraud dextrose agar grew C. lusitaniae, C. parapsilosis, and G. candidum. After topical 0.2% and systemic fluconazole treatment, the corneal lesion resolved with no recurrence. Conclusions: Corneal trauma with vegetables and the indiscriminate use of corticosteroids are important risk factors for mycotic keratitis. A combination of topical 0.2% and systemic fluconazole therapy was effective in the treatment of this mycotic association. This is the first report of fungal keratitis caused by C. lusitaniae and G. candidum.