epicardial adipose tissue-bone crosstalk

Objectives: Osteocalcin (OC) appears to be involved in the regulation of glucose and fat metabolism. We aimed to determine the association between OC and epicardial adipose tissue (EAT) in premenopausal obese women. Design: The study included 73 premenopausal obese women and 55 non-obese women. Echocardiographic examination was performed to measure EAT. Serum OC levels were measured by chemiluminescence immunoassay. Results: OC levels were significantly lower in obese women than controls (18.26 +/- 5.27 vs. 22.53 +/- 6.84 ng/ml, p < .001). EAT thickness was higher in obese women than controls (5.19 +/- 0.73 vs. 3.25 +/- 1.35 mm, p < .001). In obese women, OC was positively correlated with EAT thickness (p = .043; r = 0.326). There was no correlation in controls. Conclusions: Premenopausal obese women had lower OC levels and thicker EAT than controls. There was a weak positive correlation between OC and EAT in premenopausal obese women. This potential cross talk between bone metabolism and EAT could play a role in the development of atherosclerosis in obesity.C1 [Yaylali, Yalin Tolga] Pamukkale Univ, Fac Med, Dept Cardiol, Denizli, Turkey.[Fidan-Yaylali, Guzin] Pamukkale Univ, Fac Med, Dept Endocrinol & Metab Dis, Denizli, Turkey.[Dedeoglu, Ozen] Marmara Univ Training & Res Hosp, Dept Hematol, Istanbul, Turkey.[Senol, Hande] Pamukkale Univ, Fac Med, Dept Biostat, Denizli, Turkey

Effects of substitutive therapy on right ventricular systolic and diastolic functions in patients with idiopathic hypogonadotropic hypogonadism.

BACKGROUND: There have been controversial studies evaluating ventricular functions in patients with idiopathic hypogonadotropic hypogonadism (IHH). A recent study has demonstrated that low serum testosterone levels are associated with increased cardiovascular mortality. AIM: We aimed to investigate ventricular functions by standard echocardiography and examine the effects of substitutive therapy on right ventricular (RV) functions in patients with IHH by means of pulsed wave tissue Doppler imaging (PWTDI). METHODS: Twenty-three patients with IHH and 31 controls were evaluated by standard echocardiography and PWTDI. Isovolumic acceleration (IVA), myocardial systolic wave (Sm) velocity, myocardial precontraction time (PCTm), and PCTm to contraction time (CTm) ratio were determined as systolic indices. Myocardial relaxation time (RTm), early (Em) velocity, late (Am) velocity, and Em to Am ratio were determined as diastolic indices. RESULTS: Peak pulmonary artery pressure (PAP) was significantly higher in control subjects (p=0.008). IVA and Sm values were similar in patients and controls. Em, Am velocities, and their ratios did not differ. PCTm was significantly longer (p=0.001) and PCTm to CTm ratio was significantly higher in patients (p=0.001). These parameters also decreased after replacement therapy, albeit not statistically significantly (p>0.05). PAP was significantly higher after substitutive therapy (p=0.009). CONCLUSIONS: Ventricular functions are normal in patients with IHH. Substitutive therapy has no effects on RV functions. However, substitutive therapy may increase PAP in small amounts, which has no immediate clinical implication with short-term use

Effect of microalbuminuria on corneal endothelium in patients with diabetes without retinopathy

Background: The aim of this study was to investigate the effect of microalbuminuria on corneal endothelium in patients with diabetes without retinopathy. Methods: This cross-sectional study comprised 100 patients with type 2 diabetes mellitus (DM) without diabetic retinopathy and 92 control subjects without diabetes. Forty-five patients had microalbuminuria and 55 subjects were microalbuminuria negative. Endothelial measurements were obtained using specular microscopy. Endothelial cell density, average area, co-efficient of variation, maximum area, minimum area, hexagonality and corneal thickness were compared between the groups on the basis of microalbuminuria, DM duration and medication, HbA1c, body mass index, serum lipid and protein profiles, hypertension and hyperlipidaemia diagnosis. Results: There were no significant differences in age, gender, endothelial cell density, average area, co-efficients of variation, maximum area, minimum area, hexagonality or corneal thickness among the microalbuminuria positive, microalbuminuria negative and control groups (p &gt; 0.05). However, microalbuminuria positive patients had lower high-density lipoprotein levels than the microalbuminuria negative patients (p = 0.042). DM and control groups showed similar endothelial measurements (p &gt; 0.05). Patients with a HbA1c &gt; 7 per cent (53 mmol/mol) had lower hexagonality value (p = 0.039) than in the subjects with a HbA1c ≤ 7 per cent. No significant differences were found in endothelial parameters when groups were compared based on DM duration, medication and co-morbidities. Conclusions: Microalbuminuria positive and negative patients with DM without retinopathy seem to have similar corneal endothelial measurements with controls. However, patients with a HbA1c &gt; 7 per cent should be monitored for deterioration in corneal endothelial cell morphology even without diabetic retinopathy, which might be critical prior to anterior segment surgery. © 2019 Optometry Australi

Effect of microalbuminuria on corneal endothelium in patients with diabetes without retinopathy.

BACKGROUND: The aim of this study was to investigate the effect of microalbuminuria on corneal endothelium in patients with diabetes without retinopathy. METHODS: This cross-sectional study comprised 100 patients with type 2 diabetes mellitus (DM) without diabetic retinopathy and 92 control subjects without diabetes. Forty-five patients had microalbuminuria and 55 subjects were microalbuminuria negative. Endothelial measurements were obtained using specular microscopy. Endothelial cell density, average area, co-efficient of variation, maximum area, minimum area, hexagonality and corneal thickness were compared between the groups on the basis of microalbuminuria, DM duration and medication, HbA(1c) , body mass index, serum lipid and protein profiles, hypertension and hyperlipidaemia diagnosis. RESULTS: There were no significant differences in age, gender, endothelial cell density, average area, co-efficients of variation, maximum area, minimum area, hexagonality or corneal thickness among the microalbuminuria positive, microalbuminuria negative and control groups (p > 0.05). However, microalbuminuria positive patients had lower high-density lipoprotein levels than the microalbuminuria negative patients (p = 0.042). DM and control groups showed similar endothelial measurements (p > 0.05). Patients with a HbA(1c) > 7 per cent (53 mmol/mol) had lower hexagonality value (p = 0.039) than in the subjects with a HbA(1c) ≤ 7 per cent. No significant differences were found in endothelial parameters when groups were compared based on DM duration, medication and co-morbidities. CONCLUSIONS: Microalbuminuria positive and negative patients with DM without retinopathy seem to have similar corneal endothelial measurements with controls. However, patients with a HbA(1c) > 7 per cent should be monitored for deterioration in corneal endothelial cell morphology even without diabetic retinopathy, which might be critical prior to anterior segment surgery

Early retinal neurodegeneration in preclinical diabetic retinopathy: a multifactorial investigation

Background/Objectives: To investigate effects of microalbuminuria (MA), diabetes duration, glycosylated haemoglobin (HbA1c) level, hypertension (HT) and/or hyperlipidaemia (HL) coexistence on retinal layers in diabetic patients without diabetic retinopathy (DR) using spectral-domain optical coherence tomography (SD-OCT). Subjects/Methods: This cross-sectional study involved 95 (45 had MA and 50 had no MA) patients with type 2 diabetes mellitus (DM) without DR and 91 age- and gender-matched non-diabetic controls. Macular and peripapillary SD-OCT measurements (Heidelberg Engineering GmbH, Heidelberg, Germany), DM duration, HbA1c levels and presence of HT and/or HL were used for statistical analyses. Results: The MA (+), MA (−) and control groups had similar age and gender distribution (p > 0.05). The differences in SD-OCT measurements among the MA (+), MA (−) and control groups were insignificant (p > 0.05). However, diabetic patients (n = 95) had significantly thinner inferior-temporal peripapillary retinal nerve fibre layer (RNFL) (p = 0.042) than in the controls (n = 91). Superior peripapillary RNFL was significantly thinner in patients with an HbA1c level > 7% (p = 0.049). However, 3 mm-nasal, temporal and superior perifoveal thicknesses were significantly lower in patients with DM duration over 10 years (p < 0.05). HT and/or HL coexistence did not lead a significant difference in SD-OCT parameters among the groups. Conclusions: In diabetic patients without DR, peripapillary inferior-temporal RNFL thinning might be an early sign of neuroretinal degeneration and it seems to be independent from vascular endothelial damage (MA). Poor metabolic control appears to lead superior peripapillary RNFL thinning, while perifoveal thicknesses tend to decrease with longer DM duration. © 2019, The Author(s), under exclusive licence to The Royal College of Ophthalmologists

Successful treatment of visceral leishmaniasis with fluconazole and allopurinol in a patient with renal failure.

Standard treatments for visceral leishmaniasis (antimonials, amphotericin B and pentamidine) pose several problems. Failure of antimonials or severe toxicity is particularly troublesome in patients with renal insufficiency. We report a case of visceral leishmaniaisis and renal insufficiency successfully treated with fluconazole and allopurinol for 4 months

Obesity

Objective: To determine the relationship between central adiposity parameters and autonomic nervous system (ANS) dysfunction. Subjects and Methods: The study included 114 obese individuals without any cardiovascular risk factors. Weight (in kg), height (in m), and waist circumference (WC; in cm) were measured and body mass index was calculated. Echocardiographic examination was performed to measure left ventricular mass and epicardial fat thickness (EFT). All the participants underwent an exercise test and electrophysio-logical evaluation using electromyography. Heart rate recovery (HRR) at 1-5 min, R-R interval variation at rest and during hyperventilation, and sympathetic skin response were measured. Pearson's correlation analysis was used. Multiple linear regression analysis was used to identify the factors associated with autonomic dysfunction. Results: The HRR at 1-5 min was negatively correlated with WC and age (WC-HRR1: r = -0.32; WC-HRR2: r = -0.31; WC-HRR3: r = -0.26; WC-HRR4: r = -0.23; WC-HRR5: r = -0.21; age-HRR2: r = -0.32; age-HRR3: r = -0.28; age-HRR4: r = -0.41; age-HRR5: r = -0.42). Age was the only independent predictor of reduced HRR at 1-5 min. In addition, WC predicted a reduced HRR at 3 min. There were no significant associations between central obesity and electrophysiological parameters. EFT was not associated with ANS dysfunction. Conclusion: In this study, central adiposity and aging were associated with ANS dysfunction in obese individuals. The WC could be a marker of ANS dysfunction in obese individuals without any cardiovascular risk factors. The HRR assessment at a later decay phase could be more valuable for evaluating ANS function than during early recovery. (C) 2016 S. Karger AG, Base

Early retinal neurodegeneration in preclinical diabetic retinopathy: a multifactorial investigation.

BACKGROUND/OBJECTIVES: To investigate effects of microalbuminuria (MA), diabetes duration, glycosylated haemoglobin (HbA1c) level, hypertension (HT) and/or hyperlipidaemia (HL) coexistence on retinal layers in diabetic patients without diabetic retinopathy (DR) using spectral-domain optical coherence tomography (SD-OCT). SUBJECTS/METHODS: This cross-sectional study involved 95 (45 had MA and 50 had no MA) patients with type 2 diabetes mellitus (DM) without DR and 91 age- and gender-matched non-diabetic controls. Macular and peripapillary SD-OCT measurements (Heidelberg Engineering GmbH, Heidelberg, Germany), DM duration, HbA1c levels and presence of HT and/or HL were used for statistical analyses. RESULTS: The MA (+), MA (-) and control groups had similar age and gender distribution (p > 0.05). The differences in SD-OCT measurements among the MA (+), MA (-) and control groups were insignificant (p > 0.05). However, diabetic patients (n = 95) had significantly thinner inferior-temporal peripapillary retinal nerve fibre layer (RNFL) (p = 0.042) than in the controls (n = 91). Superior peripapillary RNFL was significantly thinner in patients with an HbA1c level > 7% (p = 0.049). However, 3 mm-nasal, temporal and superior perifoveal thicknesses were significantly lower in patients with DM duration over 10 years (p < 0.05). HT and/or HL coexistence did not lead a significant difference in SD-OCT parameters among the groups. CONCLUSIONS: In diabetic patients without DR, peripapillary inferior-temporal RNFL thinning might be an early sign of neuroretinal degeneration and it seems to be independent from vascular endothelial damage (MA). Poor metabolic control appears to lead superior peripapillary RNFL thinning, while perifoveal thicknesses tend to decrease with longer DM duration

Malign cystic glucagonoma presented with diabetic ketoacidosis: case report with an update.

A 44-year-old woman was diagnosed with type II diabetes in 1998 and 1 year later she developed necrolytic migratory erythema, which is a specific skin lesion of glucagonoma. During the clinical investigation, a nodular 6 cm mass in the distal pancreatic region and multiple cystic liver metastases were found. She was operated on, and glucagonoma was detected and the long-acting, repeatable, octreotide treatment was started. 3 years after resection of a pancreatic glucagonoma she presented to a hospital emergency department with diabetic ketoacidosis. Hepatic multiple cystic metastases were visualized by computed tomography. During hospitalization she developed severe pulmonary embolism and deep-venous thrombosis of the lower extremities. Indium-labeled octeotide scintigraphy showed multiple cystic lesions in the liver with additional lesions in the iliocecal region, which had not been visualized by computed tomography. Despite somatostatin therapy the tumor had expanded in the liver. Arterial chemoembolization was performed but 6 months later she died