Usporedba stvarnog profila lipida u bolesnika s dijabetesom tip 2 i preporuka iz smjernica

Diabetes is a major risk factor for cardiovascular disease. Despite recommendations and available therapeutic options, patients with diabetes do not always reach the recommended lipid levels. In this study, our aim was to compare the real world lipid profile of type 2 diabetes patients with guideline recommendations for dyslipidemia. Four hundred and sixty eight consecutive patients referred to Outpatient Diabetes Clinic of Istanbul Medeniyet University were recruited. Patient anthropometric measurements (height, weight, waist circumference), biochemical test results (LDL cholesterol (LDL-c), triglycerides, HDL cholesterol, HbA1c) and treatment modalities were recorded. Patients were stratified into cardiovascular risk categories according to the risk factors and their treatment dose was compared to the recommendations. Among 468 patients, 56 (12%) patients had coronary heart disease (CHD). Thirty-four percent of these patients were not on statin treatment (n=19) and their mean LDL-c level was 114±29 mg/dL (2.9±0.75 mmol/L). Nineteen percent of these patients were on high intensity statin treatment (atorvastatin 40-80 mg, rosuvastatin 20 mg). Only four patients with CHD had LDL-c levels <70 mg/dL (1.8 mmol/L). Four hundred and twelve patients had no CHD. In these patients, the mean LDL-c level was 132±38 mg/dL (3.4±0.9 mmol/L). Eighty (19%) patients had LDL-c level lower than 100 mg/dL (2.5 mmol/L). Overall 82% (n=384) of the cohort had not achieved treatment goal. In conclusion, a more pronounced approach for statin treatment is needed in diabetes patients for both primary and secondary prevention of cardiovascular diseases.Dijabetes je glavni čimbenik rizika za srčanožilne bolesti. Usprkos preporuka i dostupnih terapijskih mogućnosti bolesnici s dijabetesom ne postižu uvijek preporučene razine lipida. Cilj ovoga istraživanja bio je usporediti stvarni profil lipida u bolesnika s dijabetesom tip 2 s preporukama za dislipidemiju iz dotičnih smjernica. U istraživanje je bilo uključeno 468 uzastopnih bolesnika upućenih u Ambulantu za dijabetes Sveučilišta Medeniyet u Istanbulu. Bilježena su antropometrijska mjerenja (visina, težina, opseg struka), rezultati biokemijskih pretraga (LDL kolesterol, trigliceridi, HDL kolesterol, HbA1c) i načini liječenja. Bolesnici su podijeljeni u skupine kardiovaskularnog rizika prema rizičnim čimbenicima, a doze lijeka kojom su liječeni uspoređene su s preporukama. Među 468 bolesnika 56 (12%) ih je imalo koronarnu srčanu bolest (KSB); 34% (n=19) tih bolesnika nije primalo terapiju statinima, a njihova srednja razina LDL bila je 114±29 mg/dL (2,9±0,75 mmol/L); 19% tih bolesnika primalo je visoko intenzivnu terapiju statinima (atorvastatin 40-80 mg, rosuvastatin 20 mg). Razine LDL <70 mg/dL (1,8 mmol/L) zabilježene su u samo četvero bolesnika s KSB. Četiristodvanaest bolesnika nije imalo KSB. U ovih bolesnika srednja razina LDL bila je 132±38 mg/dL (3,4±0,9 mmol/L). Razine LDL niže od 100 mg/ dL (2,5 mmol/L) zabilježene su u 80 (19%) bolesnika s LDL. Dakle, cilj liječenja sveukupno nije postignut u 82% (n=384) ispitivanih bolesnika. Zaključuje se kako je potreban snažniji pristup terapiji statinima u bolesnika s dijabetesom kako za primarnu tako i za sekundarnu prevenciju srčanožilnih bolesti

Long-term exposure to outdoor and household air pollution and blood pressure in the prospective urban and rural epidemiological (pure) study

Exposure to air pollution has been linked to elevated blood pressure (BP) and hypertension, but most research has focused on short-term (hours, days, or months) exposures at relatively low concentrations. We examined the associations between long-term (3-year average) concentrations of outdoor PM2.5 and household air pollution (HAP) from cooking with solid fuels with BP and hypertension in the Prospective Urban and Rural Epidemiology (PURE) study. Outdoor PM2.5 exposures were estimated at year of enrollment for 137,809 adults aged 35–70 years from 640 urban and rural communities in 21 countries using satellite and ground-based methods. Primary use of solid fuel for cooking was used as an indicator of HAP exposure, with analyses restricted to rural participants (n = 43,313) in 27 study centers in 10 countries. BP was measured following a standardized procedure and associations with air pollution examined with mixed-effect regression models, after adjustment for a comprehensive set of potential confounding factors. Baseline outdoor PM2.5 exposure ranged from 3 to 97 μg/m3 across study communities and was associated with an increased odds ratio (OR) of 1.04 (95% CI: 1.01, 1.07) for hypertension, per 10 μg/m3 increase in concentration

Serologic Testing for Celiac Disease in Graves' Hyperthyroidism: Should We Act Early?

Background: The general practice is to screen patients with autoimmune thyroid disease for celiac disease (CD); however, optimal timing for CD screening for patients with Graves'Disease (GD) has not been identified yet. The aim of the study was to show whether positive celiac antibodies persist after euthyroidism is achieved. Materials and Methods: Serum samples were collected from 35 patients with GD (23 female and 12 male) who applied to the endocrine outpatient clinic. Patients and healthy controls were screened for CD with IgG and IgA antigliadin antibodies (IgG - AGA and IgA - AGA), IgA endomysial antibody (IgA-EMA) and IgA tissue transglutaminase antibody (IgA anti-tTG). These antibodies were reevaluated when patients were euthyroid under antithyroid therapy. Small intestine biopsy was offered to the patients who remained antibody positive after being euthyroid. Results: Screening 35 patients with GD revealed positive results for IgA-AGA (n = 6/35, 17%), IgG-AGA (n = 9/35, 26%), IgA-EmA (n = 2/35, 6%) and IgA-tTG (n = 2/35, 6%). No patient had multiple antibodies positive. Selective IgA deficiency was not detected in patients and controls. When patients were euthyroid, baseline positive IgA-AGA, IgG-AGA, and IgA-EmA became negative, while positive anti-tTG persisted in two patients. Endoscopic duodenal biopsy showed a normal villi/crypts ratio in these patients. None of the controls had positive antibodies. Conclusion: Due to possibility of false seropositivity of celiac antibodies in patients with Graves' thyrotoxicosis, one should defer testing for CD until euthyroidism has been achieved

Novel Anti-obesity Therapies and their Different Effects and Safety Profiles: A Critical Overview

Obesity has become an epidemic and a worldwide problem and its treatment is ever-evolving. Apart from diet and exercise, medication and surgery are other options. After disappointing side effects of various obesity drugs, new treatments showed promising results. This review discusses the following anti-obesity drugs: liraglutide, semaglutide, tirzepatide, orlistat, as well as the phenter-mine/topiramate and bupropion/naltrexone combinations. These drugs have been approved by the Food and Drug Administration (FDA) for weight reduction except for tirzepatide which is still under evaluation. Efficacy and tolerable safety profiles of some of these drugs contribute to the management of obesity and reduce the complications associated with this chronic disease

ERUPTIVE XANTHOMA: A MARKER OF HYPERTRIGLYCERIDEMIA

Eruptive xanthomas are benign lesions which are found in extensor surfaces of the extremities and are often associated with hypertriglyceridemia and/or uncontrolled diabetes. In this case report, we present a patient with hypertriglyceridemia, type 2 diabetes mellitus and eruptive xanthomas who recovers fully after treatment. A 37-year-old male patient presented to our clinic with reddish yellow lesions on his elbows. His body mass index was 30 kg/m(2) and his laboratory results showed high serum triglyceride and glucose levels (triglyceride 6548 mg/dL, glucose 245 mg/dL), his hemoglobin A1c was 11.2%. Although eruptive xanthomas have a benign nature, they are associated with disease which often need lifelong treatment

The Frequency and Determinants of HbA1c Variability in Type 2 Diabetic Patients

Aim: Glycated hemoglobin (HbA1c) is an efficient and easy test to evaluate glycemic control of patients with type 2 diabetes (T2DM). This study aims to evaluate HbA1c variability and associated factors in patients with T2DM

Assessment of subclinical cardiovascular alterations in nonfunctioning adrenal incidentalomas

Background/aim: Adrenal incidentalomas have been associated with increased cardiovascular risk and have a prevalence as high as 10%. This study aims to evaluate carotid-intima media thickness (CIMT), left ventricular mass, and epicardial adipose tissue thickness in nonfunctioning adrenal incidentaloma patients and compare their results with healthy controls. Materials and methods: Patients who were referred to the endocrinology clinic for adrenal incidentaloma between 2014 and 2019 were assessed with 1 mg dexamethasone suppression test, 24-h urine metanephrines and normetanephrines, plasma aldosterone to renin ratio. Age and gender-matched subjects without an adrenal mass formed the control group. Left ventricular mass, epicardial adipose tissue thickness, and CIMT of both groups were measured. Results: A total of 41 adrenal incidentaloma patients (21 female, 52.5%) and 40 healthy controls (19 female, 46.3%) were included in the study. Patients with adrenal incidentalomas had increased CIMT. No differences were observed in left ventricle mass or epicardial adipose tissue thickness. There was no correlation between CIMT and adenoma size or serum cortisol (p = 0.2 and p = 0.6, respectively). There was a statistically significant correlation between CIMT and age (p = 0.016, r = 0.295). HBA1c (p = 0.001) and age (p = 0.05) were independently associated with CIMT in regression analysis. Conclusion: Adrenal incidentaloma patients need to be monitored for cardiac dysfunction. CIMT may be used to evaluate adrenal incidentaloma patients for early cardiovascular risk

Optimal testosterone level to improve symptoms of hypogonadism without causing dopa-testotoxicosis in male macroprolactinoma

Background. - Male prolactinoma treatment by dopamine agonists (DA) restores sexual function. However, excessive DA dose can lead to impulse control disorder. Objectives. - The aim of this retrospective study was to determine the level of testosterone that eliminates symptoms and provides fertility in male macroprolactinoma, without causing these adverse effects. Materials and methods. - Twenty-seven male patients with macroprolactinoma were included. There were 16 macro (> 1-2.8 cm), 7 large macro (> 2.9-3.9 cm) and 4 giant (> 4 cm) adenomas. Prolactin (PRL) and testosterone (T) levels were evaluated. A timeline was created to analyze improvement in symptoms of hypogonadism and infertility. Testosterone levels were compared with age-matched controls. Results. - Mean PRL, basal tumor diameter and shrinkage were 2846 +/- 3415 ng/mL, 27.2 +/- 10.2 mm and 63.4%, respectively. Basal T levels were 1.6 +/- 1.0 ng/mL for patients and 4.4 +/- 1.5 ng/mL for controls (P < 0.001). Mean T level in the asymptomatic period was significantly lower than in controls (3.2 +/- 0.4 ng/mL vs. 4.4 +/- 1.5 ng/mL, respectively; P = 0.002), while mean PRL was 27.2 ng/mL. Fertility was achieved in 6 of the patients seeking fertility, and there was no difference in T level between these patients and controls (3.7 +/- 0.8 ng/mL and 4.4 +/- 1.5 ng/mL, respectively; P = 0.14); when fertility was achieved, mean PRL was 26.9 +/- 23 ng/mL. Conclusion. - Patients should be carefully questioned regarding complaints at each consultation, and DA dose should not be increased unnecessarily, to avoid possible serious adverse effects. (c) 2021 Published by Elsevier Masson SAS