Effect of acute iron infusion on insulin secretion: A randomized, double-blind, placebo-controlled trial.

Chronic exposure to high iron levels increases diabetes risk partly by inducing oxidative stress, but the consequences of acute iron administration on beta cells are unknown. We tested whether the acute administration of iron for the correction of iron deficiency influenced insulin secretion and the production of reactive oxygen species. Single-center, double-blinded, randomized controlled trial conducted between June 2017 and March 2020. 32 women aged 18 to 47 years, displaying symptomatic iron deficiency without anaemia, were recruited from a community setting and randomly allocated (1:1) to a single infusion of 1000 mg intravenous ferric carboxymaltose (iron) or saline (placebo). The primary outcome was the between group mean difference from baseline to day 28 in first and second phase insulin secretion, assessed by a two-step hyperglycaemic clamp. All analyses were performed by intention to treat. This trial was registered in ClinicalTrials.gov NCT03191201. Iron infusion did not affect first and second phase insulin release. For first phase, the between group mean difference from baseline to day 28 was 0 μU × 10 min/mL [95% CI, -22 to 22, P = 0.99]. For second phase, it was -5 μUx10min/mL [95% CI, -161 to 151; P = 0.95] at the first plateau of the clamp and -249 μUx10min/mL [95% CI, -635 to 137; P = 0.20] at the second plateau. Iron infusion increased serum ascorbyl/ascorbate ratio, a marker of plasma oxidative stress, at day 14, with restoration of normal ratio at day 28 relative to placebo. Finally, high-sensitive C-reactive protein levels remained similar among groups. In iron deficient women without anaemia, intravenous administration of 1000 mg of iron in a single sitting did not impair glucose-induced insulin secretion despite a transient increase in the levels of circulating reactive oxygen species. The Swiss National Science Foundation, University of Lausanne and Leenaards, Raymond-Berger and Placide Nicod Foundations

Les infections pneumococciques: état des lieux et perspectives en matière de vaccination de l'adulte [Pneumococcal infections: Appraisal and perspectives in terms of adult vaccination].

Pneumococcal diseases are the first cause of bacterial infections in adult and in the aged adult. While its considerable morbi-mortality is potentially preventable through vaccination, the interest of anti-pneumococcal vaccination in these populations is still debated. Effectiveness appraisal of current anti-pneumococcal vaccines and the perspectives in terms of preventive strategies against Streptococcus pneumoniae infections in the adult population are presented

Impact of dietary and obesity genetic risk scores on weight gain.

Whether genetic background and/or dietary behaviors influence weight gain in middle-aged subjects is debated. To assess whether genetic background and/or dietary behaviors are associated with changes in obesity markers (BMI, weight, and waist and hip circumferences) in a Swiss population-based cohort. Cross-sectional and prospective (follow-up of 5.3 y) study. Two obesity genetic risk scores (GRS) based on 31 or 68 single nucleotide polymorphisms were used. Dietary intake was assessed using a semiquantitative FFQ. Three dietary patterns "Meat & fries" (unhealthy), "Fruits & vegetables" (healthy), and "Fatty & sugary" (unhealthy), and 3 dietary scores (2 Mediterranean and the Alternative Healthy Eating Index [AHEI]) were computed. On cross-sectional analysis (N = 3033, 53.2% females, 58.4 ± 10.6 y), obesity markers were positively associated with unhealthy dietary patterns and GRS, and negatively associated with healthy dietary scores and patterns. On prospective analysis (N = 2542, 54.7% females, age at baseline 58.0 ± 10.4 y), the AHEI and the "Fruits & vegetables" pattern were negatively associated with waist circumference gain: multivariate-adjusted average ± SE 0.96 ± 0.25 compared with 0.11 ± 0.26 cm (P for trend 0.044), and 1.14 ± 0.26 compared with -0.05 ± 0.26 cm (P for trend 0.042) for the first and fourth quartiles of the AHEI and the "Fruits & vegetables" pattern, respectively. Similar inverse associations were obtained for changes in waist >5 cm: multivariate-adjusted OR (95% CI): 0.65 (0.50, 0.85) and 0.67 (0.51, 0.89) for the fourth versus the first quartile of the AHEI and the "Fruits & vegetables" dietary pattern, respectively. No associations were found between GRS and changes in obesity markers, and no significant gene-diet interactions were found. Dietary intake, not GRS, are associated with waist circumference in middle-aged subjects living in Lausanne, Switzerland

Troubles neurocognitifs chez les personnes âgées avec maladie oncologique [Cancer-related cognitive impairment in older adults]

Chemotherapy is associated with transient or permanent cognitive dysfunction ranging from subjective complaints to measurable deficits in working memory, attention and language. Given that old age may be related to cognitive decline, the interaction between chemotherapy-induced cognitive impairment and the effects of age is of growing concern in view of our aging population. Chemotherapy-associated cognitive dysfunction may have an additive impact on pre-existing age-related cognitive performance decline, which calls for awareness in its detection, to reduce impact on quality of life and improve management of older patients. We discuss here the « chemobrain », concept, review the existing evidence about pathophysiology, neuroimaging and cognitive phenotype and propose practical tools for routine detection in the outpatient setting

Cancer-related cognitive impairment in older adults

Chemotherapy is associated with transient or permanent cognitive dysfunction ranging from subjective complaints to measurable deficits in working memory, attention and language. Given that old age may be related to cognitive decline, the interaction between chemotherapy-induced cognitive impairment and the effects of age is of growing concern in view of our aging population. Chemotherapy-associated cognitive dysfunction may have an additive impact on pre-existing age-related cognitive performance decline, which calls for awareness in its detection, to reduce impact on quality of life and improve management of older patients. We discuss here the « chemobrain », concept, review the existing evidence about pathophysiology, neuroimaging and cognitive phenotype and propose practical tools for routine detection in the outpatient setting

[2015 highlights in hospital-based internal medicine by chief residents].

The year 2015 gave us many scientific publications, among whom some will have an impact on our daily practice and some will influence our way of considering some well known diseases. Chief residents in the Service of internal medicine of the Lausanne University hospital, gathered like every year, to share their readings together in order to presentyou a small part of the many publications of 2015, which have been considered to have an impact on our future daily practice