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'Inventi Impact: Endocrinology (Formerly Inventi Impact: Diabetes)' is a peer reviewed journal of health sciences. The journal carries research and review papers related to abnormalities in carbohydrate metabolism, endocrine system and insulin synthesis. The aim of the journal is to extend knowledge about treatment, management and education of diabetes and associated diseases.
Glucose monitoring and diabetes management go hand in hand. Evolution of
glucose monitoring and diagnostic tools was a necessary step in better diagnosis
and management of diabetes. With time we have seen improvements in
terms of accuracy, time and sample collection. Some of the greatest initial
advancements in this field were brought forward by the work of scientists
who are sometimes not credited for the extraordinary work they have done.
The first sample to be used in terms of glucose detection was urine, after
which came blood and interstitial fluid. Development of newer methods of
glucose monitoring range from urine sampling to usage of interstitial fluid,
with each method being unique in terms of utility....
We report the case of a woman with a sporadic medullary thyroid carcinoma. Genomic analysis found that her tumor did not\ncontain any common RET mutations but did harbor a BRAF V600E mutation. Only one other well-confirmed example of the\nBRAF V600E mutation has been reported in an MTC patient. We conclude that this common BRAF mutation may independently\ndrive neoplastic transformation of human parafollicular C cells....
Diabetic Ketoacidosis commonly presents with hyponatremia, but hypernatremia is a rare entity. We report a unique case\nof a 50-year-old woman admitted with altered sensorium with blood glucose 979 milligrams/deciliter, serum osmolarity 363\nmOsm/kilograms, and serum sodium 144 milliequivalents/liter. Patient was given initial bolus of isotonic saline and continued\non half isotonic saline for correction of hypernatremia along with insulin infusion therapy. Patient was successfully treated with\nintravenous fluids, insulin infusion, and the altered sensorium was resolved without any sequelae. This case illustrates a teaching\npoint in the use of intravenous fluids for the treatment of Diabetic Ketoacidosis with hypernatremia....
Background: Thyroid associated orbitopathy (TAO) is defined as an immune mediated inflammatory process\naffecting the extraocular muscles, connective and adipose tissue of uncertain etiopathogenesis. TAO are classically\ndescribed in Graveâ??s disease (GD) however it may occur in euthyroid and hypothyroid patients. Those patients\nusually test positive for Thyroid Stimulating Hormone receptor antibodies (TRAb). For instance, only few cases of\nsevere Hashimotoâ??s thyroiditis (HT) associated orbitopathy with negative TRAb are reported to date.\nCase presentation: Herewith we report a rare case of a middle-aged female who presented with bilateral\nprogressive upper and lower palpebral edema and a unilateral marked proptosis associated with asthenia,\nheadache and decrease in visual acuity. Biological investigation was notable for high levels of anti-thyroid\nperoxidase antibodies (Anti-TPO) in an otherwise euthyroid patient with negative TRAb. Orbital Magnetic resonance\nimaging revealed edema of the extraocular muscles and inflammation of periorbital soft tissue. The patient received\na treatment with intravenous methylprednisolone followed by oral treatment with prednisone. This regimen was\nboth effective and safe with minimal metabolic side effects in our patient.\nConclusion: Minor ocular manifestations of HT are common; however, severe sight threatening ophtalmopathy in\nthe absence of TRAb is rare. Multiple differential diagnosis should be considered and investigated before\ndiagnosing this rare entity. Management of similar cases is currently based on reports and no clear guidelines have\nbeen elaborated, corticosteroids is the mainstream of treatment with a potential benefit of selenium\nsupplementation in mild to moderate cases....
Background: Florida Firefighters experience a higher risk of thyroid cancer than non-firefighters. This study examines
whether the histologic types and tumor stage of thyroid cancer is different among firefighters compared to other
Methods: Eligible cases were firefighters (n = 120) identified in a linkage of Florida Cancer Data System (FCDS)
registry records (1981–2014) and Florida State Fire Marshal’s Office employment and certification records, and nonfirefighters
classified into: blue-collar (n = 655), service (n = 834), white-collar (n = 4,893), and other (n = 1,789). Differences
in thyroid histologic type (papillary, follicular, and rare/other less common forms of thyroid cancer), tumor stage,
and age at diagnosis were evaluated using multinomial logistic regression models comparing blue-collar, service,
white-collar, and other occupational groups with firefighters. Univariate odds ratios as well as odds ratios adjusted for
age, gender, race, tumor stage, and year of diagnosis (aOR) and 95% confidence intervals (95%CI) were reported.
Results: Service (aOR = 4.12; 95%CI: 1.25—13.65), white-collar (aOR = 3.51; 95%CI: 1.08—11.36), and blue-collar
(aOR = 4.59; 95%CI: 1.40—15.07) workers had significantly higher odds of being diagnosed with rare histologic types
of thyroid cancer vs papillary type compared to firefighters. Service (aOR = 0.42; 95%CI: 0.27—0.66), white-collar
(aOR = 0.39; 95%CI: 0.26—0.59), blue-collar (aOR = 0.36; 95%CI: 0.23—0.56), and other (aOR = 0.34; 95%CI: 0.22—0.53)
occupational groups have a significantly lower odds of being diagnosed with rare vs papillary type at a younger age
(30—49 years) vs 50—69 years compared to firefighters. However, stage at diagnosis was not significantly different
among occupational groups.
Conclusion: Firefighters diagnosed with thyroid cancer experience a higher odds of papillary compared to rare
histologic types of thyroid cancer relative to other workers; there is no evidence of an increased odds of late-stage
diagnosis in firefighters relative to other worker groups. Firefighters may benefit from routine screening and active
surveillance of suspected thyroid tumors especially given the excellent treatment outcomes available for those diagnosed
with early-stage papillary thyroid tumors....
How we manage T1DM has changed dramatically and significantly over the
past 57 years. The information I have detailed below is my perspective on
how my family and I monitored and treated my T1DM 57 years ago as we
were taught by the amazing nursing staff at Resurrection Hospital. Great
strides with T1DM have been made since starvation diets and with the discovery
of insulin 100 years ago: the discovery of insulin at the Department of
Physiology, University of Toronto, Canada, in 1921-22 was one of the most
dramatic events in the history of therapeutics. Insulin’s impact was so exciting
and sensational because of the incredible effect it had on Type 1 patients
with diabetes-truly a miracle of medicine in the 20th century. Frederick Banting
and Charles Best won the Nobel Prize in 1922: “called one of the greatest
achievements of modern medicine”....
Background: 11 patients were referred to our Molecular Genetics Department at the Royal Devon and Exeter\nHospital between 2000-2012 with a physicianÃ¢â?¬â?¢s diagnosis of remitting diabetes. Our aim was to identify patients\nwith remitting diabetes whose clinical presentation is not explained by any known aetiology of diabetes.\nMethods: We obtained longitudinal clinical data on all 11 patients from the hospital records. All patients were\naged between 0.5 and 35 years at diagnosis. We applied clinical criteria derived from the literature to establish\n1) definite diabetes, 2) diabetes initially severe-requiring treatment with insulin, 3) remission of diabetes, and\n4) exclusion of known causes of remitting diabetes.\nResults: 10 out of 11 patients had an alternative explanation for their remission or a clear diagnosis was not\nidentified. We identified a single patient with idiopathic remitting diabetes using these criteria. The patient was a\nwhite Caucasian female diagnosed aged 15 with symptoms of diabetes, laboratory glucose of 21.2 mmol/L and\nHbA1c 134 mmol/mol. Her BMI was 23.6 kg/m2. She was treated with basal bolus insulin but discontinued two\nyears after diagnosis due to hypoglycaemia. 13 years post diagnosis, she had a normal oral glucose tolerance\ntest during pregnancy (fasting glucose 4.5 mmol/L, 2 hr glucose 4.8 mmol/L) and an HbA1c of 30 mmol/mol.\nThis patient does not appear to have Type 1 or Type 2 diabetes, and furthermore does not fit into current\nclassifications of diabetes.\nConclusions: Idiopathic remitting diabetes is rare but does exist. Strict clinical criteria are important to ensure\npatients have a robust clinical diagnosis. Identification of more patients with idiopathic remitting diabetes will\nenable further study of the clinical course of this syndrome. Applying these strict criteria will allow the identification\nof patients with remitting diabetes to assess its aetiology....
Theaimof the studywas to test the performance of a newdefinition of metabolic syndrome (MetS),which better describes metabolic\ndysfunction in children. Methods. 15,794 youths aged 6Ã¢â?¬â??18 years participated. Mean z-score for CVD risk factors was calculated.\nSensitivity analyses were performed to evaluate which parameters best described the metabolic dysfunction by analysing the score\nagainst independent variables not included in the score. Results.More youth had clustering of CVD risk factors (>6.2%) compared\nto the number selected by existingMetS definitions (International Diabetes Federation (IDF) < 1%).Waist circumference and BMI\nwere interchangeable, but using insulin resistance homeostasis model assessment (HOMA) instead of fasting glucose increased the\nscore. The continuous MetS score was increased when cardiorespiratory fitness (CRF) and leptin were included. A mean z-score\nof 0.40Ã¢â?¬â??0.85 indicated borderline and above 0.85 indicated clustering of risk factors. A noninvasive risk score based on adiposity\nand CRF showed sensitivity and specificity of 0.85 and an area under the curve of 0.92 against IDF definition ofMetS. Conclusions.\nDiagnosis for MetS in youth can be improved by using continuous variables for risk factors and by including CRF and leptin....
not yet been well documented. This study aimed to establish a practical model for thyroid nodule discrimination.\nMethods: Records for 2984 patients who underwent thyroidectomy were analyzed. Clinical, laboratory, and US\nvariables were assessed retrospectively. Multivariate logistic regression analysis was performed and a mathematical\nmodel was established for malignancy prediction.\nResults: The results showed that the malignant group was younger and had smaller nodules than the benign group\n(43.5 Ã?Â± 11.6 vs. 48.5 Ã?Â± 11.5 y, p < 0.001; 1.96 Ã?Â± 1.16 vs. 2.75 Ã?Â± 1.70 cm, p < 0.001, respectively). The serum thyrotropin\n(TSH) level (median = 1.63 mIU/L, IQR (0.89Ã¢â?¬â??2.66) vs. 1.19 (0.59Ã¢â?¬â??2.10), p < 0.001) was higher in the malignant group than\nin the benign group. Patients with malignancies tested positive for anti-thyroglobulin antibody (TGAb) and anti-thyroid\nperoxidase antibody (TPOAb) more frequently than those with benign nodules (TGAb, 30.3% vs. 15.0%, p < 0.001;\nTPOAb, 25.6% vs. 18.0%, p = 0.028). The prevalence of ultrasound (US) features (irregular shape, ill-defined margin,\nsolid structure, hypoechogenicity, microcalcifications, macrocalcifications and central intranodular flow) was\nsignificantly higher in the malignant group. Multivariate logistic regression analysis confirmed that age (OR = 0.963, 95%\nCI = 0.934Ã¢â?¬â??0.993, p = 0.017), TGAb (OR = 4.435, 95% CI = 1.902Ã¢â?¬â??10.345, p = 0.001), hypoechogenicity (OR = 2.830, 95%\nCI = 1.113Ã¢â?¬â??7.195, p = 0.029), microcalcifications (OR = 4.624, 95% CI = 2.008Ã¢â?¬â??10.646, p < 0.001), and central intranodular\nflow (OR = 2.155, 95% CI = 1.011Ã¢â?¬â??4.594, p < 0.05) were independent predictors of thyroid malignancy. A predictive\nmodel including four variables (age, TGAb, hypoechogenicity and microcalcification) showed an optimal discriminatory\naccuracy (area under the curve, AUC) of 0.808 (95% CI = 0.761Ã¢â?¬â??0.855). The best cut-off value for prediction was 0.52,\nachieving sensitivity and specificity of 84.6% and 76.3%, respectively.\nConclusion: A predictive model of malignancy that combines clinical, laboratory and sonographic characteristics\nwould aid clinicians in avoiding unnecessary procedures and making better clinical decisions....
Background: Low levels of vitamin D have been related to increased mortality and morbidity in several non-diabetic\nstudies. We aimed to prospectively study relationships between serum 25-OH vitamin D3 (vitamin D) and of serum\nparathyroid hormone (PTH) to total mortality in type 2 diabetes. We also aimed to compare the levels of these potential\nrisk-factors in patients with and without diabetes.\nMethods: The main study design was prospective and observational. We used baseline data from 472 men and\n245 women who participated in the Ã¢â?¬Å?Cardiovascular Risk factors in Patients with DiabetesÃ¢â?¬â?a Prospective study in\nPrimary careÃ¢â?¬Â study. Patients were 55Ã¢â?¬â??66 years old at recruitment, and an age-matched non-diabetic sample of\n129 individuals constituted controls for the baseline data. Carotid-femoral pulse-wave velocity (PWV) was measured\nwith applanation-tonometry and carotid intima-media thickness (IMT) with ultrasound. Patients with diabetes were\nfollowed for all-cause mortality using the national Swedish Cause of Death Registry.\nResults: Levels of vitamin D were lower in patients with diabetes than in controls, also after correction for age and\nobesity, while PTH levels did not differ. Nine women and 24 men died during 6 years of median follow up of the final\ncohort (n = 698). Vitamin D levels were negatively related to all-cause mortality in men independently of age, PTH,\nHbA1c, waist circumference, 24-h systolic ambulatory-blood pressure (ABP) and serum-apoB (p = 0.049). This finding\nwas also statistically significant when PWV and IMT were added to the analyses (p = 0.028) and was not\naffected statistically when medications were also included in the regression-analysis (p = 0.01). In the women with type\n2 diabetes, levels of PTH were positively related with all-cause mortality in the corresponding calculations\n(p = 0.016 without PWV and IMT, p = 0.006 with PWV and IMT, p = 0.045 when also adding medications to the\nanalysis), while levels of vitamin D was without statistical significance (p >0.9).\nConclusions: Serum vitamin D in men and serum PTH in women give prognostic information in terms of total-mortality\nthat are independent of regular risk factors in addition to levels of ABP, IMT and PWV....
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