Synchronicity of frequently sampled, 24-h concentrations of circulating leptin, luteinizing hormone, and estradiol in healthy women

Leptin, an adipocyte hormone, is a trophic factor for the reproductive system; however, it is still unknown whether there is a dynamic relation between fluctuations in circulating leptin and hypothalamic—pituitary–ovarian (HPO) axis hormones. To test the hypothesis that fluctuations in plasma leptin concentrations are related to the levels of luteinizing hormone (LH) and estradiol, we sampled plasma from six healthy women every 7 min for 24 h during days 8–11 of the menstrual cycle. Cross-correlation analysis throughout the 24-h cycle revealed a relation between release patterns of leptin and LH, with a lag of 42–84 min but no significant cross-correlation between LH and estradiol. The ultradian fluctuations in leptin levels showed pattern synchrony with those of both LH and estradiol as determined by cross-approximate entropy (cross-ApEn). At night, as leptin levels rose to their peak, the pulsatility profiles of LH changed significantly and became synchronous with those of leptin. LH pulses were fewer, of longer duration, higher amplitude, and larger area than during the day. Moreover, the synchronicity of LH and leptin occurred late at night, at which time estradiol and leptin also exhibited significantly stronger pattern coupling than during the day. We propose that leptin may regulate the minute-to-minute oscillations in the levels of LH and estradiol, and that the nocturnal rise in leptin may determine the change in nocturnal LH profile in the mid-to-late follicular phase that precedes ovulation. This may explain the disruption of hypothalamic—pituitary–ovarian function that is characteristic of states of low leptin release, such as anorexia nervosa and cachexia.     

The correlation of hip fracture and hyponatremia in the elderly

Background: Increasing age is considered one of the risk factors for hyponatremia. The concept of asymptomatic hyponatremia is not correct anymore as these patients have a greater risk for falls, bone fractures and attention impairment. The combination of old age and a fall is a common recipe for admission to a nursing home. Methods: We identified 249 patients 65 years of age or older who were admitted to hospital with the diagnosis of hip fracture secondary to fall, during a 3-year period. We compared their serum Na level on admission with that of controls: 44 ambulatory patients admitted for elective hip or knee replacement surgery during the same time frame. Odds ratios (ORs) were calculated using logistic regression. Results: The prevalence of hyponatremia in cases was 16.9%, versus 4.6% in controls (p=0.03). Age and hyponatremia were strongly correlated with hip fracture secondary to fall. The univariate OR for hip fracture associated with each 10-year increase in age was 5.57 (p<0.0001). After controlling for age, cases were almost 5 times as likely as controls to be hyponatremic (OR=4.80, p=0.04). Conclusions: Even mild hyponatremia in the elderly should be considered a risk factor for falls. Correction of hyponatremia in the elderly may reduce morbidity and mortality, and at the same time, it has a huge impact on socioeconomic status.     

Alterations of lipids and apolipoprotein CIII in very low density lipoprotein subspecies in type 2 diabetes

Aims/hypothesis Very low density lipoprotein (VLDL) particles are heterogeneous, comprising two main subspecies, VLDL 1 (Sf 60-400) and VLDL 2 (Sf 20-60). The aim of the study was to examine the distribution and composition of VLDL subspecies in type 2 diabetes.Subjects, materials and methods We studied the composition and concentration of triglyceride-rich lipoproteins (TRLs) in 217 type 2 diabetic patients and 93 control subjects between 50 and 75 years of age. Lipoprotein subspecies were separated by density-gradient ultracentrifugation. Apolipoprotein (apo) CIII and apo E in plasma and apo CIII in TRL subspecies were measured by nephelometry and apo CII in serum by a commercial kit using a single radial immunodiffusion method.Results The concentrations of VLDL 1, VLDL 2 and intermediate density lipoprotein were significantly increased in type 2 diabetes subjects, the change being most marked for VLDL 1. There was a strong linear correlation between VLDL 1 triglycerides and plasma triglycerides in both groups (r=0.879, p<0.001 and r=0.899, p<0.001). Diabetic subjects had markedly higher plasma ratios of apo CII:apo CIII and apo CIII:apo E. Despite elevated plasma apo CIII, type 2 diabetic subjects had a relative deficiency of apo CIII in all TRL subspecies, suggesting profound disturbances of apo CIII metabolism.Conclusions/interpretation The elevation of VLDL 1 triglycerides is the major determinant of plasma triglyceride concentration in normal subjects and in type 2 diabetic individuals. Both apo CIII and apo E metabolism are disturbed in type 2 diabetes.     

Intrainfusion and postinfusion adverse events related to intravenous immunoglobulin therapy in immunodeficiency states.

The i.v. immunoglobulin (IVIG) therapy is one of the mainstays of treatment for humoral immunodeficiencies, but there is limited knowledge of the adverse reactions associated with this therapy, especially reactions occurring in the postinfusion period. The purpose of this prospective, observational, multicenter study was to identify and quantify the adverse reactions that can occur both during and after IVIG infusions (Gamimune N) in patients with humoral immunodeficiency. Patients with primary immunodeficiencies requiring IVIG therapy were followed over a 6-month period, and data regarding adverse events, particularly the time of onset, duration, and type of reaction associated with IVIG infusions wzas collected via direct observation and patient interviews. Data were obtained during and up to 72 hours after the completion of infusions. Sixty-five patients were recruited and received a total of 447 infusions over a 6-month period. Four hundred fifty-one adverse reactions were noted, with 17% of infusions associated with an intrainfusion reaction and 41% associated with a postinfusion reaction. Most postinfusion reactions occurred within 24 hours of the infusion and consisted mainly of headaches, fatigue, and nausea. Adverse reactions to Gamimune N infusions are common and occur primarily in the postinfusion period. Estimates of the rate of adverse reactions to Gamimune N infusions currently are underestimated because they do not account for postinfusion reactions. In addition, once recognized, effective treatment of postinfusion reactions may improve patient compliance and quality of life.     

Travel-Related AIDS Awareness Among Young Gulf Arab Men

Background: The Federal Ministry of Health of the United Arab Emirates (UAE) has a vigorous AIDS control programme that conforms to international guidelines. Available information on HIV infection in the AI Ain district (UAE) shows a low incidence among its citizens and a low frequency of spread by the sexual route. This is in keeping with cultural factors perceived to have withstood the potential for sexual spread in the Arabian Gulf area. However, there is an acknowledged concern for the risk to young male citizens while traveling abroad to popular destinations such as India, Thailand, and the Philippines.
Methods: The authors attempted to determine the knowledge and attitude about AIDS among Emirati males (aged 18–25 years) by confidential, self-administered questionnaire (modification of a tested approach in the UK). A total sample of 298 subjects participated (94% response), comprising 47 medical students (16%), 194 nonmedical students (65%), and 57 school graduates (19%). Of all participants, 253 (85%) were unmarried.
Results: Salient discriminatory findings were that medical students significantly differed from the other two groups in stating that AIDS could not be identified in a person by appearance (p=.003) and that the use of condoms was protective while traveling abroad (p<.001). The latter issue also reflected a significant difference between married and unmarried subjects, in that marital status influenced a positive response to the protective role of condoms. Among all subjects, 41% had visited Asian countries outside the Gulf region and 20% intended to visit.
Conclusion: This study demonstrated a prevailing uncertainty about AIDS knowledge and a possible fear of AIDS, both of which tend to increase acceptance of special education programmes.     

Laboratory and field evaluation of the IGR fenoxycarb against mosquitoes

A new juvenile hormone mimic [fenoxycarb or RO13-5223 ethyl-(p-phenoxyphenoxy) ethylcarbamate] was evaluated in the field against Culex tarsalis in stagnant water ponds, Psorophora columbiae and Aedes melanimon in irrigated pastures. This material, showing high level of activity against Cx. quinquefasciatus in laboratory, was found to be highly effective against field populations of the 3 former species. A 5% attaclay granular formation yielded 100% inhibition of emergence in Cx. tarsalis at the rate of 0.1 lb/acre ai, 2 days after treatment. The extent of control declined markedly 7 days after treatment. An EC and 1% sand coated granular formulation yielded poor control providing 91 and 69% inhibition of emergence 2 days posttreatment at the high rate of 0.25 lb/acre ai. The 2 flood water mosquitoes were about 10 X more susceptible than Cx. tarsalis. The EC and 1% attaclay granular formulations produced 100% inhibition of emergence of the floodwater mosquitoes Ps. columbiae and Ae. melanimon in irrigated pastures at the rate of 0.01 lb/acre ai, while Cx. tarsalis required 0.1 lb/acre ai for this level of EI. Most of the mortality in treatments with this insect growth regulator was noted in the pupal stage, very few dying in the larval stage or as adults upon emergence. From extensive field studies, it can be concluded that fenoxycarb has excellent potential in operational mosquito control programs.