Depression and microvascular complications predict poor goal achievement among Colombian patients with type 2 diabetes

Aims: Many patients with type 2 diabetes (DM2) in Latin American countries remain insufficiently controlled. We aimed to identify factors associated with persistent poor metabolic control in Colombian patients with DM2. Methods: Retrospective one-year follow-up cohort study of adult patients with DM2. The primary outcome was persistent poor metabolic control (PPMC): HbA1c level >8% in all measurements during follow-up. Secondary outcomes were intermittent poor metabolic control (IPMC) and good control (GC: simultaneous achievement of HbA1c, blood pressure and LDL cholesterol goals). Multiple demographic, clinical and laboratory variables were predictors in multivariable logistical models. Results: Of 399 patients included, 50 had the primary endpoint during follow-up. Older age was negatively associated with PPMC (OR 0.40, 95%CI 0.17-0.92 for extreme quartiles), even after multivariate adjustment. Depression and the presence of multiple microvascular complications were strongly associated with the secondary endpoint IPMC (multivariate OR respectively 4.2, 95%CI 1.08-16.4 for depression; 5.61, 95%CI 1.03-30.6 for microvascular complications). Being unemployed was associated with significantly less odds of achieving GC (multivariate OR 0.19, 95%CI 0.04-0.95). Conclusions: Age, depression, the presence of microvascular complications and employment status were associated with the success or failure of diabetes management. These factors were better correlates of therapeutic success than the pharmacological agent employed

Unusual Course of an Aggressive Pituitary Prolactinoma: Case Report and Review of the Literature

Pituitary carcinomas are rare tumors with heterogeneous behaviors. Their carcinogenesis is still unknown. Consequently, treatment is multimodal and not standardized. Dopamine (DA) agonists are used as first-line treatments, while radiotherapy and surgery may be used for local control of invasive tumors. We describe the case of a 35-year-old male who presented with an invasive prolactinoma, managed initially with a transsphenoidal resection, postsurgical radiotherapy and DA agonists. The patient posteriorly presented a sole metastatic lesion to the lumbar spine that was later managed with local radiotherapy. Due to pituitary recurrence of the lesion, multiple surgical resections were needed until further treatment was declined. The clinical course in this patient was unusual. He lived for 13 years after initial diagnosis, with a very invasive tumor without systemic chemotherapy. Radiotherapy is used in pituitary tumors in which surgery fails; we hypothesize that it contributed to the malignant transformation and the late resistance to DA agonists in our patient. Several biomarkers in tumoral tissue have been evaluated regarding their association with malignancy and aggressive behaviors, although more studies are still needed. Therapeutic strategies are limited, without evidence on the impact on overall survival and prognosis. Risk factors associated with early malignancy in pituitary prolactinomas include recurrent behavior, increase in prolactin levels with a stable sellar mass, and secondary development of DA agonist resistance. However, there are still no conclusive answers as to whether physicians should rigorously follow up these patients or provide direct therapy with aggressive approaches

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

Insuficiencia de vitamina D en pacientes adultos con baja masa ósea y osteoporosis en la Fundación Santa Fe de Bogotá 2008–2009

Hypovitaminosis D is associated with osteoporosis, neuromuscular diseases, autoimmune diseases and cancer. The prevalence varies from 11–70% in different populations. Due osteoporosis is a common disease, we determined the prevalence of hypovitaminosis D associated with bone demineralization in FSFB population evaluated between August 2008 and July 2009, we reviewed age, gender, T-Score, Z-score. Values between 32–150 ng/ml were considered as normal. We found 460 25OHD results, 105 subjects with mineral density for DXA method, 80% female. Mean age for women was 66 years (SD ± 12.5, range 39–91) for women was 67.1 years (SD ± 12.2, range 39–91) for men was 61 years (SD ± 10.7, range 42–82). Mean 25OHD levels were 31 ng / ml (SD ± 17.6, range 8.2 to 110), for women 30.5 ng / mL (SD ± 16.1, range 10.6 to 96 ng / mL), for men 33.5 ng / mL (SD ± 23.4, range 8.2 to 110 ng / mL). 69,5% of cases were considered as vitamin D insufficiency, 45,7% mild, 23,8% moderate, and no cases of severe déficit. No significant difference between 25OHD concentrations and gender, or age were considered. Osteoporosis was correlated with 25OHD levels below 28 ng/ml (P=0,046) but not between low 25OHD and subjects with osteopenia. The vitamin D deficiency is highly prevalent in patients with osteoporosis and low bone mass and should be evaluated in the context of osteoporosis. © 2010 Asociación Colombiana de Reumatologí

Insuficiencia de vitamina D en pacientes adultos con baja masa ósea y osteoporosis en la Fundación Santa Fe de Bogotá 2008–2009

"Hypovitaminosis D is associated with osteoporosis, neuromuscular diseases, autoimmune diseases and cancer. The prevalence varies from 11–70% in different populations. Due osteoporosis is a common disease, we determined the prevalence of hypovitaminosis D associated with bone demineralization in FSFB population evaluated between August 2008 and July 2009, we reviewed age, gender, T-Score, Z-score. Values between 32–150 ng/ml were considered as normal. We found 460 25OHD results, 105 subjects with mineral density for DXA method, 80% female. Mean age for women was 66 years (SD ± 12.5, range 39–91) for women was 67.1 years (SD ± 12.2, range 39–91) for men was 61 years (SD ± 10.7, range 42–82). Mean 25OHD levels were 31 ng / ml (SD ± 17.6, range 8.2 to 110), for women 30.5 ng / mL (SD ± 16.1, range 10.6 to 96 ng / mL), for men 33.5 ng / mL (SD ± 23.4, range 8.2 to 110 ng / mL). 69,5% of cases were considered as vitamin D insufficiency, 45,7% mild, 23,8% moderate, and no cases of severe déficit. No significant difference between 25OHD concentrations and gender, or age were considered. Osteoporosis was correlated with 25OHD levels below 28 ng/ml (P=0,046) but not between low 25OHD and subjects with osteopenia. The vitamin D deficiency is highly prevalent in patients with osteoporosis and low bone mass and should be evaluated in the context of osteoporosis. © 2010 Asociación Colombiana de Reumatología

Restrictive versus Liberal Rate of Extracorporeal Volume Removal Evaluation in Acute Kidney Injury (RELIEVE-AKI): a pilot clinical trial protocol

Introduction Observational studies have linked slower and faster net ultrafiltration (UFNET) rates during kidney replacement therapy (KRT) with mortality in critically ill patients with acute kidney injury (AKI) and fluid overload. To inform the design of a larger randomised trial of patient-centered outcomes, we conduct a feasibility study to examine restrictive and liberal approaches to UFNET during continuous KRT (CKRT).Methods and analysis This study is an investigator-initiated, unblinded, 2-arm, comparative-effectiveness, stepped-wedged, cluster randomised trial among 112 critically ill patients with AKI treated with CKRT in 10 intensive care units (ICUs) across 2 hospital systems. In the first 6 months, all ICUs started with a liberal UFNET rate strategy. Thereafter, one ICU is randomised to the restrictive UFNET rate strategy every 2 months. In the liberal group, the UFNET rate is maintained between 2.0 and 5.0 mL/kg/hour; in the restrictive group, the UFNET rate is maintained between 0.5 and 1.5 mL/kg/hour. The three coprimary feasibility outcomes are (1) between-group separation in mean delivered UFNET rates; (2) protocol adherence; and (3) patient recruitment rate. Secondary outcomes include daily and cumulative fluid balance, KRT and mechanical ventilation duration, organ failure-free days, ICU and hospital length of stay, hospital mortality and KRT dependence at hospital discharge. Safety endpoints include haemodynamics, electrolyte imbalance, CKRT circuit issues, organ dysfunction related to fluid overload, secondary infections and thrombotic and haematological complications.Ethics and dissemination The University of Pittsburgh Human Research Protection Office approved the study, and an independent Data and Safety Monitoring Board monitors the study. A grant from the United States National Institute of Diabetes and Digestive and Kidney Diseases sponsors the study. The trial results will be submitted for publication in peer-reviewed journals and presented at scientific conferences.Trial registration number This trial has been prospectively registered with clinicaltrials.gov (NCT05306964). Protocol version identifier and date: 1.5; 13 June 2023