Testosterone and growth hormone normalization: a retrospective study of health outcomes

Enrique Ginzburg1, Alvin Lin2, Michael Sigler1, Denise Olsen2, Nancy Klimas1, Alan Mintz21University of Miami Miller School of Medicine, Miami, Florida, USA; 2Cenegenics® Medical Institute, Las Vegas, Nevada, USABackground: Age-related declines in testosterone and growth hormone (GH) are associated with increased adiposity and decreases in lean mass and bone mineral density (BMD). A long-term retrospective study examined the effects of testosterone and/or GH supplementation on body composition and quality of life (QoL).Methods: A database survey assessed the records of 91 men and 97 women (ages 25–82) in treatment groups based on their hormonal status: dehydroepiandrosterone but no hormonal supplementation (control); testosterone only (Tes); GH only (GH); and testosterone plus GH (Tes+GH). Pre- and post-treatment assessments recorded changes in fat and lean mass, BMD, and QoL.Results: After an average of 3 years of treatment, weight decreased in women in the control and Tes+GH groups but remained stable in men in all groups. Tes and Tes+GH produced statistically significant increases in lean mass, reductions in fat mass, and improvements in BMD in both sexes; GH produced similar changes in women. QoL and mood improved in all groups. Treatments were generally safe and well tolerated.Conclusions: In this retrospective survey, treatment with testosterone and/or GH was associated with favorable effects in men and women across a wide age range.Keywords: testosterone, growth hormone, body composition, quality of lif

Long-term Safety of Testosterone and Growth Hormone Supplementation: A Retrospective Study of Metabolic, Cardiovascular, and Oncologic Outcomes

Background Clinical research into the effects of hormonal supplementation has tended to focus on beneficial changes in anthropometric measures. There are fewer data on long-term safety with extended hormonal supplementation. Methods As part of a retrospective database survey, clinical outcomes were tabulated among patients who received at least 1 year of testosterone and/or growth hormone (GH) supplementation. In patients who were treated for at least 2 years, changes in markers of glucose and lipid metabolism were analyzed with and without concomitant use of oral hypoglycemics and statins. Results In 263 patients (mean age 56) treated for at least 2 years, the only statistically significant effect on markers of glucose metabolism was an increase in glycated hemoglobin (still within normal limits) in patients receiving GH alone or in combination with testosterone but without oral hypoglycemics; with or without hypoglycemics, insulin levels showed no significant change. The only significant effects on markers of lipid metabolism were decreases in total cholesterol and low-density lipoprotein (LDL) in patients receiving combined testosterone and GH without statins. Decreases in LDL were significant in both the statin and non-statin groups; decreases in triglycerides were significant only in the statin group. In 531 patients treated for at least 1 year (mean age 54), the overall incidence of adverse clinical outcomes (prostate disease, diabetes, cardiovascular disease, cancer) was 1.3%. Conclusions In this retrospective survey, extended testosterone and/or GH supplementation did not adversely affect metabolic markers or clinical outcomes

Friedrich Hayek and his visits to Chile

F. A. Hayek took two trips to Chile, the first in 1977, the second in 1981. The visits were controversial. On the first trip he met with General Augusto Pinochet, who had led a coup that overthrew Salvador Allende in 1973. During his 1981 visit, Hayek gave interviews that were published in the Chilean newspaper El Mercurio and in which he discussed authoritarian regimes and the problem of unlimited democracy. After each trip, he complained that the western press had painted an unfair picture of the economic situation under the Pinochet regime. Drawing on archival material, interviews, and past research, we provide a full account of this controversial episode in Hayek’s life

Análisis del Patrón de Pérdida de Datos en Variables Fisiológicas al Ingreso Hospitalario

RESUMEN La falta de datos completos (FDC) en registros de trauma (RT) limita la posibilidad de realizar benchmarking institucional. En la Argentina, la Fundación Trauma desarrolló en 2009 un RT como parte de un programa inclusivo que funciona actualmente en 11 hospitales e la provincia de Buenos Aires. El propósito de esta comunicación es describir el perfil de FDC en la tensión arterial sistólica (TAS), frecuencia respiratoria (FR) y escala de coma de Glasgow (GCS) en el RT y las formas de tratamiento de los mismos. Materiales y Métodos Estudio observacional con datos deidentificados de pacientes ingresados de forma prospectiva al RT. El RT utiliza AIS, CIE, RTS, ISS y TRISS. Resultados Se registraron 12.675 hechos (18% de crecimiento interanual), de los cuales 11.886 (94%) estaban cerrados y fueron analizados. Luego de excluir a los 65 años, pacientes con lesiones en extremidades, ISS<16 y víctimas de agresiones (todos p<0,001). En los hospitales no se encontró relación entre la FDC y el volumen y la severidad de los pacientes atendidos. La FDC se evaluó por test MCAR de Little (p<0,001) por lo cual no se realizó imputación múltiple. La regresión logística mostró que tener al menos una lesión en el tórax, en la cabeza o en el abdomen, además de ser motociclista se asoció a menor FDC. Discusión En esta muestra el aspecto más sobresaliente fue la heterogeneidad de FDC entre hospitales, que osciló entre 4% y 70% para la FR (variable con mayor FDC) y que se concentró en algunos hospitales en pacientes más graves y en otros, en los más leves. Entendemos que más allá de buscar un patrón de datos perdidos ajustable al conjunto de instituciones, lo más relevante es identificar el patrón de cada una para trabajar en forma dirigida en la reducción de la pérdida de datos. Palabras claves: Heridas, Lesiones, Mortalidad hospitalaria, Puntuación de gravedad de lesiones, Registros, Trauma. How to cite this article Monteverde E, Bosque L, Maciá E, Lartigue B, Barbaro C, Ortiz C, Ginzburg E, Neira J. Análisis del Patrón de Pérdida de Datos en Variables Fisiológicas al Ingreso Hospitalario. Panam J Trauma Crit Care Emerg Surg 2016;5(3):126-133

Physicians’ perceptions of the definition of major bleeding in major orthopedic surgery: results of an international survey

Decisions regarding choice of thromboprophylaxis in patients undergoing major orthopedic surgery are based on assessment of individual patient risk for thrombosis versus risk for bleeding. An international survey sought physician views on definitions and relative importance of different types of major bleeding. A random sample of physicians from five countries (100 physicians per country, mainly surgeons) completed an internet-based 13-question survey on perceptions, concerns, and relevance of bleeding associated with thromboprophylaxis in major orthopedic surgery. Over 80% of responders were concerned or very concerned about bleeding with >70% considering surgical-site bleeding as the most concerning, and relevant type and site for bleeding. Nearly 80% of responders considered surgical-site bleeding to increase patient length of hospital stay, and >70% noted that it complicates patient rehabilitation. After fatal bleeding, bleeding leading to re-operation was ranked as the most concerning type of major bleed. Less than half of responders reported closely reading the major-bleeding definitions in clinical study publications. Most responders favored anticoagulants that could offer a reduced bleeding risk and similar venous thromboembolism (VTE) prevention compared to current anticoagulants rather than a decrease in VTE and similar bleeding risk. There is a disconnect between the definitions of major bleeding that surgeons would apply to describe bleeding associated with VTE thromboprophylaxis, and those used in clinical studies reporting the safety profiles of newer anticoagulant agents. Misperceptions about the benefit-to-harm profiles of thromboprophylactic therapies may incorrectly inform treatment choices in patients at high risk for post-operative VTE

Lingual Infarction: A Review of the Literature

Lingual infarction, although a very rare entity has been reported in 16 cases since 1961. The goal of this article is to alert the physician to the symptoms of tongue claudication to prevent the morbid effects of tongue infarction and blindness due to cranial arteritis. A discussion of the disease and the differential diagnosis is included

Conservative Management of Popliteal Aneurysm: Is There a Role for Selective Observation? A Case Report

Popliteal artery aneurysm (PAA) is the most common peripheral aneurysm, comprising 70% of these lesions. More than two thirds of these patients have bilateral aneurysms and the most common etiology is atherosclerosis. Elderly men in their sixth and seventh decade of life constitute over 90% of these patients, and up to 55% will have an aneurysm in other portions of the vascular tree. Only 3% to 5% of these aneurysms are found in women. The abdominal aorta will be involved in 30% to 75% of cases and, therefore, dictate a full work-up when a PAA is found. The authors report a case of an 80-year-old man with a chief complaint of intermittent calf pain that occurred without any pattern of distance. This atypical pattern of claudication had been recurring for more than three months. The patient underwent a duplex ultrasound that showed a dilation of his arteries measuring 1.7 cm and 2.3 cm on the right and left sides, respectively. Further work-up with a magnetic resonance image demonstrated a 4 cm x 3 cm left PAA with thrombus and a smaller aneurysm on the right side. An angiogram demonstrated single peritoneal artery runoff on the left side and posterior tibial artery runoff on the right side. The patient was cleared for surgery with an ejection fraction of 40%; however, he refused to undergo reconstruction. The patient ehas been followed up for the past four years without change in his symptomatology and repeated ultrasounds have not shown any significant size change