Factors Associated with Ulcer Healing and Quality of Life in Patients with Diabetic Foot Ulcer

A prospective nonrandomized cohort study on consecutive diabetic patients with foot ulcer was undertaken to assess the factors associated with the healing process or limb salvage and evaluate the impact of their treatment on their quality of life. Quality of life was evaluated using Diabetic Foot Ulcer Scale–Short Form (DFS-SF) questionnaire before and after treatment. A total of 103 diabetic patients with ulcer (mean age 69.7 ± 9.6 years, 77% male) were treated and followed up for 12 months. Ulcer healing, minor amputation, and major amputation rates were 41%, 41%, and 18%, respectively, while the mortality rate was 18%. Ulcer healing was associated with University of Texas wound grade 1 and the Study of Infections in Diabetic feet comparing Efficacy, Safety and Tolerability of Ertapenem versus Piperacillin/Tazobactam trial’s diabetic foot infection wound score. Limb loss was associated with nonpalpable popliteal artery, longer in-hospital stay, and delay until referral. Quality of life was improved in all domains of DFS-SF (P < .0001) throughout the cohort of our patients regardless of their outcome, and no outcome (healing, minor amputation, or major amputation) was superior to other. Significant improvement was observed in all domains of hygiene self-management after consultation during the follow-up period

The effects of old, new and emerging medicines on metabolic aberrations in PCOS

Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women of reproductive age that is associated with significant adverse short- and long-term health consequences. Multiple metabolic aberrations, such as insulin resistance (IR) and hyperinsulinaemia, high incidence of impaired glucose tolerance, visceral obesity, inflammation and endothelial dysfunction, hypertension and dyslipidemia are associated with the syndrome. Assessing the metabolic aberrations and their long term health impact in women with PCOS is challenging and becomes more important as therapeutic interventions currently available for the management of PCOS are not fully able to deal with all these consequences. Current therapeutic management of PCOS has incorporated new treatments resulting from the better understanding of the pathophysiology of the syndrome. The aim of this review is to summarize the effect of old, new and emerging therapies used in the management of PCOS, on the metabolic aberrations of PCOS. © 2012, SAGE Publications. All rights reserved

Vitamin B12 insufficiency is associated with increased risk of gestational diabetes mellitus: a systematic review and meta-analysis

Purpose: Vitamin B12 deficiency has been associated with a plethora of metabolic abnormalities, such as hyperhomocysteinaemia, insulin resistance and defective synthesis of neurotransmitters and fatty acids. Inconsistency exists as to whether vitamin B12 deficiency is also associated with increased risk of gestational diabetes mellitus (GDM). The purpose of this study was to systematically review and meta-analyze the existing evidence for this association. Methods: A comprehensive search was conducted in PubMed, Scopus and Cochrane Central up to April 30, 2019. Data are expressed as odds ratio (OR) with 95% confidence interval (CI). The I2 index was employed for heterogeneity. Results: Six studies (n = 1810 pregnant women, 309 GDM cases) fulfilled the eligibility criteria for qualitative and two studies for quantitative analysis. In five studies providing data on vitamin B12 concentrations for both groups, women with GDM had lower vitamin B12 levels when compared with non-GDM women. Women with vitamin B12 deficiency were at higher risk for developing GDM when compared with those who were vitamin B12 sufficient: OR 1.81 (95% CI, 1.25–2.63, I2: 0%). Due to the small number of studies, the role of potential confounders could not be safely estimated. Conclusions: Vitamin B12 deficiency seems to be associated with increased risk of GDM. More studies are needed to further strengthen this finding and to clarify possible pathogenetic mechanisms. © 2019, Springer Science+Business Media, LLC, part of Springer Nature

Familial partial lipodystrophy (FPLD): Recent insights

Lipodystrophies are a heterogeneous group of congenital or acquired disorders, characterized by partial or generalized loss of adipose tissue. Familial partial lipodystrophy (FPLD) presents with genetic and phenotypic variability with insulin resistance, hypertrigly-ceridemia and hepatic steatosis being the cardinal metabolic features. The severity of the metabolic derangements is in proportion with the degree of lipoatrophy. The underpinning pathogenetic mechanism is the limited capacity of adipose tissue to store lipids leading to lipotoxicity, low-grade inflammation, altered adipokine secretion and ectopic fat tissue accumulation. Advances in molecular genetics have led to the discovery of new genes and improved our knowledge of the regulation of adipose tissue biology. Diagnosis relies predominantly on clinical findings, such as abnormal fat tissue topography and signs of insulin resistance and is confirmed by genetic analysis. In addition to anthropometry and conventional imaging, new techniques such as color-coded imaging of fat depots allow more accurate assessment of the regional fat distribution and differentiation of lipodystrophic syndromes from common metabolic syndrome phenotype. The treatment of patients with lipodystrophy has proven to be challenging. The use of a human leptin analogue, metreleptin, has recently been approved in the management of FPLD with evidence suggesting improved metabolic profile, satiety, reproductive function and self-perception. Preliminary data on the use of glucagon-like peptide 1 receptor agonists (GLP1 Ras) and sodium-glucose co-transporter 2 (SGLT2) inhibitors in cases of FPLD have shown promising results with reduction in total insulin requirements and improvement in glycemic control. Finally, investigational trials for new therapeutic agents in the management of FPLD are underway. © 2020 Bagias et al

Female sexual response models

The recent development of the field of sexual medicine has necessitated the understanding of how women are motivated and function sexually. The term "sexual response cycle" refers to a model that depicts sexual function diagram-matically, according to steps proposed by various researchers. Following their early research, Masters and Johnson proposed a linear model consisting of four phases, namely, sexual excitement-arousal, plateau, orgasm and resolution. Later, Kaplan modified that model and introduced the three-phase model of sexual response, with desire, arousal and orgasm. The models of Masters and Johnson and of Kaplan both received criticism by later researchers, who argued that their linear nature could not describe the complex female sexual function adequately and expressed their concerns about the issues of orgasm and sexual desire motives. Finally, Basson proposed a circular model of sexual response, introducing the innovative idea of non-sexual motives for sexual activity and revising the nature and role of desire in the cycle, which is now placed not at the beginning of the response cycle, but in the intermediate phases. According to Basson, the results of sexual activity, such as emotional closeness, strengthening of the marital relationship and the invigoration of self-confidence, motivate a woman to act sexually, while pure sexual desire comes up later, during the phase of stimulation-arousal, in the form of responsive desire. Understanding of the proposed sexual response models is necessary for those conducting research on women's sexual function and its disorders. In addition to the general evaluation of sexual problems, researchers need to ascertain how the individual woman behaves sexually, especially in view of later study results showing that the currently used assessment tools tend to reveal higher rates of sexual dysfunction in women when Basson's sexual response model is followed. © Athens Medical Society

Mycophenolate mofetil as rescue treatment for autoimmune liver disease in children: A 5-year follow-up

10.1016/j.jhep.2009.02.024Journal of Hepatology511156-160JOHE

Alterations in hearing function of patients with glucose disorders

Objective: To study the prevalence of hearing impairment in patients with various glucose disorders. Patients and methods: A total of 499 individuals were studied, 51 patients with type 1 (TIDM), 188 patients with type 2 diabetes mellitus (T2DM), 39 patients with impaired fasting glucose (IFG), and 221 controls. Measurements were performed, blood was drawn, and a relevant questionnaire was completed. Ηearing function was assessed by pure-tone audiometry (PTA) and distortion product otoacustic emissions (DPOAEs). Results: Patients with impaired glucose metabolism (IGM: T2DM or IFG) compared to controls had a higher percentage of abnormal PTA and DPOAEs for both the right (70.2 vs. 56.9% and 40.4 vs. 24.2%, respectively, p 0.05) and lower levels for the right ear (35.3 vs. 56.9% and 13.7 vs. 24.2%, respectively, p < 0.001 and p = 0.044) percentages of abnormal PTA and DPOAEs compared to controls. Logistic regression analysis indicated that independent parameters for abnormal DPOAEs in one or both ears are age, male gender, exposure to noisy environments, and the presence of IGM. Conclusions: Hearing impairment was more prevalent in patients with IGM compared to healthy controls, as assessed by PTA and DPOAEs. Age, male gender, and exposure to noise are other factors that can independently affect hearing ability. Physicians should bear in mind possible defects in hearing ability when dealing with such patients. © 2019, Hellenic Endocrine Society

Alterations in hearing function of patients with glucose disorders

Objective: To study the prevalence of hearing impairment in patients with various glucose disorders. Patients and methods: A total of 499 individuals were studied, 51 patients with type 1 (TIDM), 188 patients with type 2 diabetes mellitus (T2DM), 39 patients with impaired fasting glucose (IFG), and 221 controls. Measurements were performed, blood was drawn, and a relevant questionnaire was completed. Ηearing function was assessed by pure-tone audiometry (PTA) and distortion product otoacustic emissions (DPOAEs). Results: Patients with impaired glucose metabolism (IGM: T2DM or IFG) compared to controls had a higher percentage of abnormal PTA and DPOAEs for both the right (70.2 vs. 56.9% and 40.4 vs. 24.2%, respectively, p &lt; 0.001) and the left (74.1 vs. 59.3% and 47.5 vs. 25.4%, respectively, p &lt; 0.001) ear. Patients with TIDM had similar levels for the left ear (54.9 vs. 59.3% and 27.5 vs. 25.4%, respectively, p &gt; 0.05) and lower levels for the right ear (35.3 vs. 56.9% and 13.7 vs. 24.2%, respectively, p &lt; 0.001 and p = 0.044) percentages of abnormal PTA and DPOAEs compared to controls. Logistic regression analysis indicated that independent parameters for abnormal DPOAEs in one or both ears are age, male gender, exposure to noisy environments, and the presence of IGM. Conclusions: Hearing impairment was more prevalent in patients with IGM compared to healthy controls, as assessed by PTA and DPOAEs. Age, male gender, and exposure to noise are other factors that can independently affect hearing ability. Physicians should bear in mind possible defects in hearing ability when dealing with such patients. © 2019, Hellenic Endocrine Society