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Why you should read this article: • To understand the long-term negative physical and psychosocial consequences of precocious puberty • To learn about central precocious puberty (CPP), the more prevalent form of precocious puberty • To familiarise yourself with the factors to consider when deciding whether to treat CPP. Precocious puberty is defined as the onset of puberty before the age of eight years in girls and before the age of nine years in boys. It is associated with negative physical health consequences in the long term and can also have negative psychosocial effects, particularly in adolescence. Central precocious puberty (CPP), which is caused by the early activation of the hypothalamic-pituitary-gonadal axis, is the more prevalent form of precocious puberty. This article explains CPP and its signs, assessment, diagnosis and treatment. It also discusses the factors to consider when deciding whether or not to treat it, stressing the importance of a shared decision-making process that children and parents should be involved in. Precocious puberty must be diagnosed and managed by specialists, but all children’s nurses need a broad understanding of the condition so that they can refer children as early as possible and reassure and advise families. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Autoimmune polyglandular syndrome type 1 (APS‐1) is a rare disorder defined by the presence of at least two of the following conditions: chronic mucocutaneous candidiasis (CMC), chronic hypoparathyroidism, and Addison's syndrome. Despite the lack of CMC and autoimmune history, APS‐1 can be diagnosed using genetic testing. We present the case of a 28‐year‐old female patient with a history of hypocalcemia due to hypoparathyroidism since the age of 2 years. She presented to the endocrine clinic with hypogonadism, primary amenorrhea, and primary ovarian insufficiency. Addison's disease was eventually diagnosed, despite a negative Synacthen test. The adrenal crisis required intravenous hydrocortisone therapy. No CMC was documented, and there was no family history of such conditions. The diagnosis of APS‐1 was confirmed by genetic testing, revealing homozygous pathogenic variants of the autoimmune regulator gene. Management included oral calcium and calcitriol and oral hydrocortisone and fludrocortisone for Addison's disease. Hormonal induction of secondary sexual characteristics was initiated. The patient received combined oral estrogen and progesterone pills. This case highlights the critical significance of early recognition, thorough evaluation, and tailored treatment for patients with APS‐1 to enhance their quality of life and mitigate potentially life‐threatening complications. This underscores the importance of screening for associated minor autoimmune diseases as part of a holistic approach to care. [ABSTRACT FROM AUTHOR]

Hypothyroidism and Polycystic Ovary Syndrome (PCOS) constitute prevalent endocrine conditions that have serious effects on the health of women. Hormonal dysregulation, ovarian dysfunction, and polycystic ovarian morphology are hallmarks of PCOS, whereas insufficient thyroid hormone production causes hypothyroidism. This study explores the complex interactions between hypothyroidism and PCOS, highlighting the urgent need for a thorough understanding of their coexistence. It is crucial to understand that PCOS and hypothyroidism frequently co-occur since they both involve similar metabolic and hormonal dysregulations. The complex interrelationship between these illnesses is further highlighted by genetic predispositions and epigenetic changes. Clinical manifestations and reproductive issues in afflicted people are mostly influenced by hormonal imbalances, insulin resistance, and metabolic abnormalities. It is crucial to use a multidisciplinary approach to patient treatment, collaborating with endocrinologists, gynaecologists, primary care doctors, nutritionists, and mental health specialists. This comprehensive approach takes into account not only the hormonal and metabolic components of PCOS and hypothyroidism but also the psychological well-being of persons dealing with these conditions. The importance of understanding and treating the interaction between PCOS and hypothyroidism in clinical practice is emphasized in this study. Improved results and a higher quality of life for afflicted people can result from early diagnosis and suitable care techniques. Future research initiatives on genetic, epigenetic, and metabolic issues also show potential for improving therapeutic and diagnostic approaches, eventually improving patient care. This review provides a comprehensive understanding of the challenges linked to PCOS and hypothyroidism, emphasizing the importance of a comprehensive treatment plan for improved outcomes. [ABSTRACT FROM AUTHOR]

Background: ABO blood types are not known to cause diseases directly, but they can be vulnerable and surrender to diseases and health problems. This study aimed to evaluate the susceptibility to COVID-19 in individuals with different blood groups at different ages. Methods: An electronic health record was used in this retrospective cohort study at Shahid Beheshti Hospital. We studied 858 patients who were referred to Shahid Beheshti Hospital, we identified 434 of them as COVID-19 patients using RT-PCR. An analysis of the electronic record involved collecting retrospective laboratory data and demographic information, including age, sex, and blood type. Next, we examined the differences between the ABO blood groups of COVID-19 patients and the control group (1991 case). We used SPSS26 for statistical computations. Data were scrutinizeed with the χ2 test. P < 0.05 was considered statistically outstanding. Results: Based on the distribution of ABO blood groups in 434 COVID-19 patients, it was revealed that 288 of them were male and 146 were female, and the majority of them were in their third decade of life. A total of 159 patients (36.6%) had type B blood, 116 had type A (26.7%), 109 had type O (25.1%), and 50 had type AB (11.5%). COVID-19 patients had a higher percentage of type B and AB blood than the control group Conclusion: Our study found that the frequency ratio of blood group B was remarkably higher in patients than in the control group, which indicates that the blood group B may play a pivotal role in COVID-19 disease. [ABSTRACT FROM AUTHOR]

Background: The thyroid hormone is so essential that it is involved in the functioning of all the body systems, especially in the development of the brain in fetal life. The World Health Organization has estimated that around 2 billion individuals are suffering from thyroid disorders. Hence, it is essential to identify and diagnose hypothyroid patients so that the treatment strategy can be started at the earliest. Aims and Objectives: The present study aimed to find out the peripheral nerve conduction velocity, range, and degree of movement of joints in newly diagnosed hypothyroid women and compare them with those of normal euthyroid women. Materials and Methods: The present study was a case--control study conducted from July 2015 to March 2016. A total of 50 cases of newly diagnosed hypothyroid women and 50 age-matched euthyroid women were part of the study after obtaining written and informed consent. Thyroid estimation was performed in the Clinical Biochemistry Department by the ELISA method, and nerve conduction studies were performed in the Neurology Department. Results: The age and height of the participants were not statistically significant. Weight and body mass index were significantly higher in the cases when compared to the control group. Sensory and motor conduction velocities of the right median nerve are significantly less in these cases when compared to control group participants. Sensory and motor conduction velocities of the right ulnar nerve are significantly less in these cases when compared to control group participants. Sensory and motor conduction velocities of the left median nerve are significantly less in these cases when compared to control group participants. Sensory and motor conduction velocities of the left ulnar nerve are significantly less in these cases when compared to control group participants. The goniometric parameters (right and left sides) of the cases and control group participants were not significantly different. Conclusion: Hypothyroid women have a delay in peripheral nerve conduction velocities, including sensory and motor components, and the degree and range of movements of limb joints were not affected. A nerve conduction study may be utilized as a routine screening test for hypothyroid individuals so that hormone replacement therapy can be instituted at the earliest. [ABSTRACT FROM AUTHOR]

Determination of long COVID requires ruling out alternative diagnoses, but there has been no report on the features of alternative diagnoses. This study was a single-center retrospective study of outpatients who visited our clinic between February 2021 and June 2023 that was carried out to determine the characteristics of alternative diagnoses in patients with post-COVID-19 symptoms. In a total of 731 patients, 50 patients (6.8%) were newly diagnosed with 52 diseases requiring medical intervention, and 16 (32%) of those 50 patients (2.2% of the total) were considered to have priority for treatment of the newly diagnosed disorders over long COVID treatment. The proportion of patients with a new diagnosis increased with advance of age, with 15.7% of the patients aged 60 years or older having a new diagnosis. Endocrine and metabolic diseases and hematological and respiratory diseases were the most common, being detected in eight patients (16%) each. Although 35 of the 52 diseases (67%) were related to their symptoms, endocrine and metabolic diseases were the least associated with specific symptoms. Other disorders that require attention were found especially in elderly patients with symptomatic long COVID. Thus, appropriate assessment and differentiation from alternative diagnoses are necessary for managing long COVID. [ABSTRACT FROM AUTHOR]

Purpose: Polycystic ovary syndrome (PCOS) is the most common endocrine-reproductive disease linked not just to infertility but also to serious comorbidities. There is a reported association between low vitamin D levels and multiple health conditions including PCOS. This narrative review aims to analyze the role of vitamin D in PCOS development, use of the vitamin D in the treatment of PCOS, and the molecular basis of these observations. Methods: A Medline and PubMed research was performed, during the years 1990–2023, using a combination of keywords on such topic. According to the author's evaluation and target, papers were identified and included for a narrative review. Results: There are associations between lower levels of vitamin D and PCOS, as well as with insulin resistance, metabolic syndrome, hyperandrogenemia, metabolic and endocrine disorders as well as the onset of oxidative stress and pro-inflammatory milieu, in PCOS women. Conclusion: Vitamin D has a role in pathologic changes linked to PCOS. Molecular and clinical investigations which give new information about the role of vitamin D in the development of PCOS and related endocrine and metabolic disturbance are further needed. [ABSTRACT FROM AUTHOR]

Background: The interaction between pollution and endometriosis is a pressing issue that demands immediate attention. The impact of pollution, particularly air and water pollution, or occupational hazards, on hormonal disruption and the initiation of endometriosis remains a major issue. Objectives: This narrative review aims to delve into the intricate connection between pollution and endometriosis, shedding light on how environmental factors contribute to the onset and severity of this disease and, thus, the possible public health policy implications. Discussion: Endocrine‐disrupting chemicals (EDCs) in pollutants dysregulate the hormonal balance, contributing to the progression of this major gynaecological disorder. Air pollution, specifically PM2.5 and PAHs, has been associated with an increased risk of endometriosis by enhancing chronic inflammation, oxidative stress, and hormonal imbalances. Chemical contaminants in water and work exposures, including heavy metals, dioxins, and PCBs, disrupt the hormonal regulation and potentially contribute to endometriosis. Mitigating the environmental impact of pollution is required to safeguard women's reproductive health. This requires a comprehensive approach involving stringent environmental regulations, sustainable practices, responsible waste management, research and innovation, public awareness, and collaboration among stakeholders. Conclusion: Public health policies have a major role in addressing the interaction between pollution and endometriosis in a long‐term commitment. [ABSTRACT FROM AUTHOR]

People with endocrine disorders are at an increased risk of osteoporosis, yet their knowledge of osteoporosis prevention is rarely studied. This study aimed to assess the knowledge related to osteoporosis prevention and its associated factors among people with endocrine disorders in China. A cross-sectional study was conducted in a Chinese hospital's Department of Metabolism and Endocrinology. A total of 562 people with endocrine disorders completed the Chinese version of the Osteoporosis Prevention and Awareness Tool to assess their knowledge of osteoporosis prevention. Results showed that participants had a mean knowledge of 59.36 ± 23.90 out of 100, with only 52.1% scoring above 60 points. Being female, having higher education, with comorbidities, with a recent osteoporosis diagnosis, and having received health education related to osteoporosis prevention were associated with higher knowledge of osteoporosis prevention. Our study indicates that more efforts are needed to improve the knowledge related to osteoporosis prevention among people with endocrine disorders. This may be realized by strengthening and expanding diverse education, focusing on males and those with lower education and without comorbidities. [ABSTRACT FROM AUTHOR]

Sarcopenia is a disease mainly characterized by a decrease in skeletal muscle mass and muscle strength in the elderly population and chronic disease patients. Its main pathogenic factors include endocrine metabolic disorders, insufficient physical activity, chronic inflammation, etc. Recently, the impact of sleep disorders on sarcopenia has begun to receive attention, more studies have shown a correlation between sleep disorders and sarcopenia. Sleep disorders can lead to circadian disorders and thus affect the secretion of hormones such as insulin and sex hormones, as well as promote the secretion of pro-inflammatory inflammatory factors, all of which can lead to abnormal synthesis and breakdown of skeletal muscle proteins and may cause the development of sarcopenia. Therefore, exploring the relationship between the two and targeting sleep disorders may be effective in the prevention and treatment of sarcopenia and is a potential treatment strategy to intervene in the development of sarcopenia. [ABSTRACT FROM AUTHOR]

Male infertility is a physiological phenomenon in which a man is unable to impregnate a fertile woman during a 12-month period of continuous, unprotected sexual intercourse. A growing body of clinical and epidemiological evidence indicates that the increasing incidence of male reproductive problems, especially infertility, shows a very similar trend to the incidence of diabetes within the same age range. In addition, a large number of previous in vivo and in vitro experiments have also suggested that the complex pathophysiological changes caused by diabetes may induce male infertility in multiple aspects, including hypothalamic-pituitary–gonadal axis dysfunction, spermatogenesis and maturation disorders, testicular interstitial cell damage erectile dysfunction. Based on the above related mechanisms, a large number of studies have focused on the potential therapeutic association between diabetes progression and infertility in patients with diabetes and infertility, providing important clues for the treatment of this population. In this paper, we summarized the research results of the effects of diabetes on male reproductive function in recent 5 years, elaborated the potential pathophysiological mechanisms of male infertility induced by diabetes, and reviewed and prospected the therapeutic measures. [ABSTRACT FROM AUTHOR]

Objective: To assess the quality of life (QOL) among type 2 diabetes patients aged 30–64 years belonging to middle and high income group and to find out the factors associated with it. Research design and methods: A cross-sectional study was done in a tertiary care hospital in Delhi, India. Using interview-based method, the investigator collected information from 150 type 2 diabetes patients. The tool used was QOLID, i.e., Quality of Life Questionnaire for Indian Diabetes patients with scores ranging from 34 to 170. Data was analyzed using software SPSS 23.0 version, and both descriptive and inferential statistics were calculated. Results: The mean QOL score in our study was 142 ± 12.2 with a median of 145 (IQR = 135–150.7). The most affected domains of QOL were general health, treatment satisfaction, and diet satisfaction. The factors which were significantly associated with QOL were age (p = 0.002), gender (p = 0.004), duration of diabetes (p < 0.001), current treatment of patient (p < 0.01), absence of complications (p = 0.002), co-morbidities (0.006), and regular exercise (p = 0.01). Patient's current on-going treatment and regular exercise were identified as determinants of QOL. Conclusion: The quality of life of diabetes patients in our study was fairly high. It was better in younger males, those taking single oral hypoglycemic drug, who were without any complications and co-morbidities, and who did regular physical exercise. The overall infrastructure, patient friendly environment and patient management system also played a big role towards good QOL of our participants. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to investigate the prevalence of depression, anxiety, and stress among in-patients diagnosed with various endocrine disorders. Quality of life (QoL) was also evaluated using the WHOQoL-BREF questionnaire. Material and Methods: The study included 110 patients. Participants were assessed for depression using the Hamilton Depression Rating Scale (HDRS), for anxiety using the Hamilton Anxiety Scale (HAM-A), and for stress using the Perceived Stress Scale (PSS). Results: The majority of patients had Type-2 Diabetes Mellitus (46.4%) or hypothyroidism (33.6%). The study showed that 22% of endocrine patients exhibited signs of depression, with the highest depression rate found among PCOD patients (58.3%). Anxiety was prevalent across all endocrine disorders, with the most severe cases found among hyperthyroid patients (66%). Regarding stress levels, most patients with Type-2 Diabetes and hypothyroidism reported moderate stress (70% and 86% respectively), while PCOD patients reported moderate (66%) and high stress (33.3%). Quality of life varied, with physical health ranging from 17.86 to 85.7 (mean 48.5), psychological health ranging from 20.83 to 70.8 (mean 50.9), social health ranging from 8.33 to 91.6 (mean 56.4), and environmental health ranging from 15.63 to 87.5 (mean 56.5). Conclusion: In conclusion, endocrine disorders can have far-reaching effects on mental health, causing depression, anxiety, and stress. Understanding these connections and integrating mental health care into treatment plans is crucial to improving patient outcomes. [ABSTRACT FROM AUTHOR]

Method-related variations in the measurement of hormones and the reference intervals used in the clinical laboratory can have a significant, but often under-appreciated, impact on the diagnosis and management of endocrine disorders. This variation in laboratory practice has the potential to lead to an errant approach to patient care and thus could cause harm. It may also be the source of confusion or result in excessive or inadequate investigation. It is important that laboratory professionals and clinicians know about these impacts, their sources, and how to detect and mitigate them when they do arise. In this review article, we describe the historical and scientific context from which inconsistency in the clinical laboratory arises. Examples from the published literature of the impact of the method, reference interval, and clinical decision threshold-related discordances on the assessment and monitoring of various endocrine disorders are discussed to illustrate the sources, causes, and effects of this variability. Its potential impact on the evaluation of growth hormone deficiency and excess, thyroid and parathyroid disorders, hyperandrogenism, hypogonadism, glucocorticoid excess and deficiency, and diabetes mellitus is elaborated. Strategies for assessment and mitigation of the discordance are discussed. The clinical laboratory has a responsibility to recognise and address these issues, and although a lot has been accomplished in this area already, there remains more to be done. [ABSTRACT FROM AUTHOR]

Purpose: Pediatric endocrine disorders (PED) are a common component of medical health challenges in Saudi Arabia. We aimed to describe the pattern and clinical outcomes of different non-diabetic pediatric endocrine disorders in Al-Baha Region, Saudi Arabia, aiming for early diagnosis and management. Methods: The clinical and laboratory data of 744 children and adolescents who presented with non-diabetic endocrine disorders and received medical care at the pediatric endocrine clinic et al.-Baha during the period from 2018 to 2022 were retrospectively analyzed based on the records. Results: A total of 744 patients were recruited, 377 were females and 361 were males with a female/male ratio of 1.04/1. The patients' ages ranged from 2 months to 17 years, with a mean age of 9.87 ± 4.59 years. The commonest endocrine disorders were thyroid disorders 234 (31.5%), short stature 176 (23.7%), obesity 123 (16.5%), and calcium phosphate metabolism disorders 117 (15.7%). Other disorders seen were pubertal disorders 27 (3.6%), adrenal gland disorders 22 (3%), syndromes with endocrine features 14 (1.9%), sex development and gender disorders 6 (0.8%), pituitary and hypothalamic disorders 4 (0.5%), and mixed endocrine disorders 4 (0.5%). PED is a substantial source of morbidity in 26 cases and mortality in 2 cases. Conclusions: Thyroid, growth, and obesity disorders were the most common PED. Pediatric endocrine disorders have a substantial source of morbidity and mortality among Saudi children and adolescents. This baseline data is useful for planning PED care at institutional and national levels. [ABSTRACT FROM AUTHOR]

Objective: Previous studies have found that neurofibromatosis 1 (NF1) is associated with an increased risk for endocrine disorders, but no comprehensive overview of the risk for specific endocrine disorders has been published. We assessed endocrine morbidity in individuals with NF1 from information on hospital admissions, surgery for endocrine disorders, and relevant medication. Design: A nationwide population registry-based cohort study. Methods: We identified 2467 individuals with NF1 diagnosed between 1977 and 2013 from the Danish National Patient Register and the RAREDIS database and 20 132 randomly sampled age- and sex-matched population comparisons. Information on endocrine diseases was identified using registrations of discharge diagnoses, surgery, and medication prescriptions. The rates of endocrine disorders in individuals with NF1 were compared with those in the comparison cohort in Cox proportional hazard models. Results: Individuals with NF1 had a higher rate than the comparison group of any endocrine discharge diagnosis (hazard ratio [HR] 1.72, 95% confidence interval [CI]: 1.58-1.87), endocrine-related surgery (2.03, 1.39-2.96), and prescribed medications (1.32, 1.23-1.42). Increased HRs were observed for diseases and surgical operations of several glands, including pheochromocytoma, and for osteoporosis, and osteoporotic fractures. Decreased rates were observed with drugs for type 2 diabetes. Women with NF1 had higher HRs for surgery of the ovaries, uterus, and sterilization, but lower rates of surgeries of cervix and prescriptions for birth control pills. Conclusions: Neurofibromatosis 1 is associated with a variety of endocrine disorders, surgery, and medication related to endocrine disease. Awareness of endocrine morbidity is important in the clinical follow-up of individuals with NF1. [ABSTRACT FROM AUTHOR]

Objectives: To determine the frequency of endocrine disorders in Beta-Thalassemia Major (BTM) patients presenting for Endocrine Evaluation to the Department of Diabetes, Endocrinology and Metabolic Diseases, Hayatabad Medical Complex, Peshawar, Pakistan, a tertiary care hospital. Method: This descriptive study was conducted in the Department of Diabetes, Endocrinology and Metabolic Diseases, Hayatabad Medical Complex, Peshawar from October 2019 to August 2021. All patients with BTM presenting for endocrine evaluation were included in the study. Height and weight were assessed and plotted on the standard charts. For secondary sexual characteristics tanner staging was used. Blood samples for hormonal profile were taken according to standard protocol and sent for endocrine assessment. Results: A Total of 135 patients BTM were enrolled in the study comprising of 70 (51.9%) males and 65 (48.1%) females. Their mean age was 14.8±3.9 years, mean height 138.5±13.01 cm, mean weight 35.9±8.4 kg, mean BMI 18.6±2.8 kg/m2, mean age of transfusion started was 6.7±3.99 months, mean duration of transfusion 13.6±4.03 years and mean duration of chelation therapy received 6.1±4.5 years. Regarding endocrine complications, out of 135 patients assessed, one hundred (74.1%) had height less than 5th centile and fifteen (11.1%) had diabetes mellitus. For thyroid and parathyroid function, 58 and 13 were tested respectively, out of which 16 (27.6%) and 6 (46.2%) had thyroid dysfunction and hypoparathyroidism. Out of 91 patients assessed for pubertal delay, 61 (67.03%) had delayed puberty. Conclusions: High percentage of endocrine complications were found in patients with BTM. Severity and multiplicity of endocrine organs involvement was dependent on duration of the disease and lack of compliance with chelation therapy. [ABSTRACT FROM AUTHOR]

The coronavirus 2019 (COVID-19) disease has long-term effects, known as post-COVID conditions (PCC) or long-COVID. Post-COVID-19 syndrome is defined by signs and symptoms that occur during or after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection which persist for more than 12 weeks and cannot be supported by an alternative diagnosis. The cardiovascular damage caused by COVID-19 in the severe forms of the disease is induced by severe systemic inflammation, considered to be one of the causes of myocardial lesions, with increased levels of circulating cytokines and toxic response mediators. We have focused on conditions that can induce long-COVID-19, or multisystem inflammatory syndrome in adults or children (MIS-C/MIS-A), with an emphasis on endocrinological and metabolic disorders. Although described less frequently in children than in adults, long-COVID syndrome should not be confused with MIS-C, which is an acute condition characterized by multisystem involvement and paraclinical evidence of inflammation in a pediatric patient who tested positive for SARS-CoV-2. At the same time, we mention that the MIS-A symptoms remit within a few weeks, while the duration of long-COVID is measured in months. Long-COVID syndrome, along with its complications, MIS-A and MIS-C, represents an important challenge in the medical community. Underlying comorbidities can expose both COVID-19 adult and pediatric patients to a higher risk of negative outcomes not only during, but in the aftermath of the SARS-CoV-2 infection as well. [ABSTRACT FROM AUTHOR]

Among risk factors for SB, maternal endocrine diseases (ED), such as thyroids dysfunction and gestational diabetes mellitus (GDM), are the most frequent. This study aimed to investigate the rate of ED in a population of SB cases collected prospectively, and the relationship between these and causes of death. This is an area-based, prospective cohort study conducted in Emilia-Romagna, Italy between January 2014 and December 2020. Data included all cases of SB (>22 weeks). From 2014 to 2020, 766 SB occurred out of a total of 232.506 births (SB rate:0.3/1000). The ED were present in 197/766 cases of SB (25.7%), respectively, 104 thyroid disease (52.8%), 74 GDM (37.5%), and 19 cases of concomitant GDM and thyroid disease (9.6%). Women who had SB associated with ED presented significantly higher mean maternal age (p < 0.001), BMI (p < 0.001), obesity (p < 0.001) and lower smoking habit (p = 0.02) respect with control group. Neonatal and placental weight of stillborn women with ED was significantly higher (p < 0.001) in respect to stillborn of the control group. Women with ED as associated condition (ReCODE classification), present significantly higher cases of SB caused by placenta pathologies (p = 0.009) namely abruptio placentae (p = 0.001) respect than control group. ED was more frequent in older and obese women experiencing SB. The main cause of death was abruptio placentae. This information can be helpful when counseling mothers with ED and planning antenatal management to prevent SB. [ABSTRACT FROM AUTHOR]

As elite athletes demonstrate through the Olympic motto 'Citius, Altius, Fortius‐ Communiter', new performance records are driven forward by favourable skeletal muscle bioenergetics, cardiorespiratory, and endocrine system adaptations. At a recreational level, regular physical activity is an effective nonpharmacological therapy in the treatment of many endocrine conditions. However, the impact of physical exercise on endocrine function and how best to incorporate exercise therapy into clinical care are not well understood. Beyond the pursuit of an Olympic medal, elite athletes may therefore serve as role models for showcasing how exercise can help in the management of endocrine disorders and improve metabolic dysfunction. This review summarizes research evidence for clinicians who wish to understand endocrine changes in athletes who already perform high levels of activity as well as to encourage patients to exercise more safely. Herein, we detail the upper limits of athleticism to showcase the adaptability of human endocrine‐metabolic‐physiological systems. Then, we describe the growing research base that advocates the importance of understanding maladaptation to physical training and nutrition in males and females; especially the young. Finally, we explore the impact of physical activity in improving some endocrine disorders with guidance on how lessons can be taken from athletes training and incorporated into strategies to move more people more often. [ABSTRACT FROM AUTHOR]

Endocrinopathies are prevalent diseases that typically affect multiple organs, and the eye and orbital tissues are often involved in endocrine disorders. Some conditions, such as diabetes and thyroid gland dysfunction, may cause serious eye pathology and even blindness. A clear insight into the pathogenesis of endocrinopathies and their ocular manifestations would enhance preventive and therapeutic measures and reduce the incidence of sight-threatening complications. This review discusses the ocular manifestations of several endocrine disorders that eye care providers are likely to encounter in clinical practice. [ABSTRACT FROM AUTHOR]

Background: Polycystic ovary syndrome (PCOS) is a complex heterogeneous disease with various symptoms, which can affect females of reproductive age. Endocrine and metabolic abnormalities such as infertility, being overweight or obese, type 2 diabetes, hyperandrogenism and increased luteinizing hormone (LH) are common in women with PCOS. Objective: This review aimed to assess the efficacy of non-chemical and herbal substances for PCOS recovery. Materials and Methods: The keywords "non-chemical treatment", "herbal treatment", "polycystic ovary syndrome" and "PCOS" were used to search for articles in the electronic databases PubMed/MEDLINE, Web of Science, Scopus, and Reaxys, published from January 2009 to December 2019. Results: 34 relevant studies were found and were briefly described in this review. The most effective herbal treatments in animal models of PCOS were used to restore abnormality in serum sex steroid profile, LH: follicle stimulating hormone ratio, steroidogenic enzymes, cardiovascular parameters, lipid profile, and glucose and estrous cycles. In PCOS patients, positive effects on PCOS due to reductions in testosterone, estrogen, LH, LH: follicle stimulating hormone ratio, and insulin levels were observed. Conclusion: The results of this review revealed the variability and efficacy of phytotherapy and non-chemical treatments associated with PCOS disease. These findings may help future studies on the etiology and treatment of this syndrome. [ABSTRACT FROM AUTHOR]

Background: New addition to complications of Type 2 DM is the thyroid dysfunction. The present study was conducted to evaluate the T3, T4, TSH in Type 2 DM along with their correlation. Material and methods: The present cross-sectional study was conducted among 240 subjects separated into two groups: Group I i.e. 120 diagnosed Type 2 Diabetes Mellitus constituting study group, and Group II i.e. 120 healthy age and gender matched individuals constituting control group. The study was conducted over a period of 2 years i.e. 2018 to 2020. The thyroid hormones Levels were analyzed with the ELISA method and HbA1C was analyzed using Ion Exchange Resin Method. The data was analyzed. Results: In the present study 240 subjects separated into two groups - 120 subjects of known Type 2 Diabetes Mellitus constituting study group and 120 subjects of healthy, age and gender matched individuals comprising control group. Among 120 cases studied 57.5% have normal level of thyroid hormones, 8.33% have high levels of thyroid hormones (Hyperthyroidism) and 34.16% have low levels of thyroid hormones (Hypothyroidism). FPG was suggestively higher in type 2 diabetes mellitus subjects (210.5±73.5mg/dl) as contrast with the non-diabetic subjects (96.3±13.4mg/dl). The serum levels of total T3 and T4 were lower in type 2 diabetes mellitus subjects as compared to the controls while the levels of serum TSH were higher in type 2 diabetes mellitus subjects as compared to the controls. All the results were extremely significant statistically (p< 0.0001). TSH showed a positive correlation with FPG while there was a negative correlation between FPG and T3; FPG and T4. Conclusion:The present study concluded that TSH showed a positive correlation with FPG while there was a negative correlation between FPG and T3; FPG and T4. [ABSTRACT FROM AUTHOR]

Objective: Fluoride exposure has been associated with thyroid dysfunction, but fluoride's impact on thyroid function in pregnancy is unclear, especially during early gestation when the fetus is dependent on maternal thyroid hormone. We examined the potential thyroid-disrupting effects of maternal fluoride exposure in pregnancy and tested whether thyroid disruption in pregnancy mediates the association between maternal fluoride exposure and child intelligence quotient (IQ) among Canadian mother-child dyads living in areas with optimal fluoridation. Participants and Methods: We measured fluoride concentrations in drinking water and in spot urine samples collected in each trimester from pregnant women enrolled in the Maternal-Infant Research on Environmental Chemicals study. We also measured thyroid hormone (thyroid stimulating hormone [TSH], free thyroxine [FT4], and total thyroxine [TT4]) levels during the first trimester of pregnancy and categorized women as euthyroid (n=1301), subclinical hypothyroid (n=100), or primary hypothyroid (n=28). Those categorized as primary hypothyroid were combined with an additional 79 women who reported clinical diagnoses at time of study enrolment (total n=107). In a sample of 1508 women, we used logistic regression to estimate the association between fluoride exposure and risk of either subclinical or primary hypothyroidism, separately, and linear regression to estimate associations between fluoride exposure and women's thyroid hormone levels (TSH, FT4, TT4). We tested effect modification by child sex and thyroid peroxidase (TPO) antibody status. In a subsample of 439 mother-child pairs, we measured child Full-Scale IQ (FSIQ) at 3-4 years of age using the Wechsler Preschool and Primary Scale of Intelligence. We used linear regression to test associations between maternal hypothyroidism or thyroid hormone levels, and children's FSIQ scores. Finally, mediation analysis in the counterfactual framework was used to estimate the proportion of the effect of maternal fluoride exposure on child FSIQ mediated by maternal hypothyroidism, through evaluation of the natural direct (not through hypothyroidism) and indirect (through hypothyroidism) effects. Results: Using categorical measures of thyroid status, a 0.5 mg/L increase in water fluoride concentration was associated with a 1.64 (95% confidence interval [CI], 1.04 to 2.58) increased odds of primary hypothyroidism. This association was stronger among women with normal TPO antibody levels (< 5.61 IU/mL) (odds ratio, 2.80; 95% CI, 1.24 to 6.36). In contrast, we did not find a significant association between maternal urinary fluoride and hypothyroidism. For continuous measures of thyroid hormone levels, a 1 mg/L increase in maternal urinary fluoride was associated with a 35% (p=0.01) increase in TSH among women pregnant with a female fetus. In our subsample analyses, children born to women with primary hypothyroidism had lower FSIQ than children of euthyroid women, especially among boys (B, 8.78; 95% CI, -16.78 to -0.79). In contrast, maternal TSH, FT4, and TT4 levels were not significantly associated with child FSIQ scores. Maternal primary hypothyroidism did not significantly mediate the relationship between maternal water fluoride concentration and child FSIQ (p natural indirect effect=.35). Conclusions: Fluoride in drinking water may increase the risk of hypothyroidism in pregnancy. Thyroid dysfunction in pregnancy may be one mechanism underlying developmental neurotoxicity of fluoride. [ABSTRACT FROM AUTHOR]

Background/Objectives: Confluent and reticulated papillomatosis is a skin condition with unclear etiology and limited understanding of risk factors, comorbidities, and treatment strategies in the pediatric population. This study aims to describe the varied presentations and outcomes of confluent and reticulated papillomatosis and report associated comorbidities in pediatric patients. Methods: In this retrospective single‐institution case‐control study, pediatric patients with a diagnosis of confluent and reticulated papillomatosis seen between 2012 and 2020 were matched approximately 1:5 with an acne vulgaris cohort based on diagnosis, setting, and time period when seen. The primary measures were the clinical features, demographics, comorbidities, treatment, and outcomes of patients with confluent and reticulated papillomatosis. Univariate and multivariable analyses were conducted to describe the association of confluent and reticulated papillomatosis with several potential risk factors and comorbidities. Results: Patients with confluent and reticulated papillomatosis typically presented in adolescence with a median age of 14 years and female predominance. In a multivariable analysis, patients with confluent and reticulated papillomatosis were significantly more likely to identify as Black, be overweight or obese, and have concurrent acanthosis nigricans compared to control patients. Most of the confluent and reticulated papillomatosis patients were treated with oral minocycline or doxycycline. Although all patients who received antibiotics responded to treatment, approximately half presented with recurrence, typically within 1–2 years of first treatment. Conclusions: Confluent and reticulated papillomatosis is a disorder that presents in adolescence and appears to be more frequent in patients who are Black, obese, or overweight, and also have acanthosis nigricans. Clinicians should assess patients with confluent and reticulated papillomatosis for comorbidities, particularly those associated with insulin resistance, which may help reduce long‐term disease burden. [ABSTRACT FROM AUTHOR]

Background: Some maternal characteristics indicate worse prognosis in pregnant women with coronavirus disease 2019 (COVID‐19). Objective: To describe the prevalence of endocrine disorders in pregnancies involving COVID‐19, and its impact on maternal outcomes. Search strategy: Search terms were "pregnancy" and "COVID‐19". Selection: PubMed, Embase, medRxiv, and Cochrane worksheet from February to July 2020 were searched. Data collection and analysis: Articles describing endocrine disorders in pregnancies with and without COVID‐19 involvement were considered. We performed meta‐analyses of prevalence using random‐effect models and estimated relative risk and 95% confidence intervals (CI) of maternal outcomes relative to presence of endocrine disorders. Main results: Articles included (n = 141) were divided into three data sets: individual (119 articles, 356 women), case series (17 articles, 1064 women), and national registries (7 articles, 10 178 women). Prevalence of obesity ranged from 16% to 46% and hyperglycemia in pregnancy (HIP) ranged from 8% to 12%. In data set 1, HIP and obesity were risk factors for severe disease in crude and age‐adjusted models, although not for intensive care unit admission. In data from two national registries, risk of dying was 5.62 (95% CI 0.30–105.95) in women with diabetes and 2.26 (95% CI 1.03–4.96) in those with obesity. Conclusion: Obesity and HIP were prevalent in pregnant women with severe COVID‐19. Synopsis: In pregnant women with COVID‐19, obesity and hyperglycemia were prevalent and associated with adverse maternal outcomes. [ABSTRACT FROM AUTHOR]

Background: Beta thalassemia major (TM) is the most common inherited genetic disorder worldwide. Patients are at risk of iron overload, which leads to various forms of tissue damage, including endocrinopathies. The aim of this study was to evaluate the prevalence and risk factors of endocrine disorders in young patients with multi-transfused TM receiving iron chelation therapy. Methods: The inclusion criteria included all known cases of TM according to hemoglobin electrophoresis data, aged 12 years or younger, during the study period. The patient's age, gender, parent's consanguinity, clinical examination, and types of iron chelating agents used were recorded. Serum ferritin level, complete blood count (CBC), blood glucose homeostasis, thyroid, and parathyroid functions were determined. Results: One hundred twenty patients met the inclusion criteria; 70% of them had malnutrition. The presence of endocrine disorders was observed in 28/120 (23.33%) patients. The most common endocrine disorders were thyroid disorders, either subclinical or clinical hypothyroidism in 11/120 (9.17%) patients, followed by abnormalities in glucose homeostasis 9/120 (7.5%). The prevalence of impaired glucose tolerance, impaired fasting glucose, and diabetes mellitus in the present study was 5 (4.17%), 4 (3.33%), and 0 (00%), respectively, while the least frequent endocrine disorder seen in our patients was hypoparathyroidism in 8/120 (6.66%). We noted that high serum ferritin levels and poor patient compliance to therapy were significantly associated with increased endocrine disorders (OR 0.98, 95% CI 0.96–0.99, P = 0.003 and OR 0.38, 95% CI 0.16:0.93, P = 0.03, respectively). Combined chelating iron agents significantly decreased the prevalence of endocrine disorders when compared with monotherapy (OR 0.40, 95% CI 0.16:0.97, P = 0.04). Conclusion: Endocrine disorders could occur in TM patients early before or equal to 12 years of life in about one-fourth of the patients. A high serum ferritin level and poor patient compliance to therapy were significantly associated with increased endocrine disorders. Combined iron-chelating agents were associated with a decreased prevalence of endocrine disorders when compared with monotherapy. [ABSTRACT FROM AUTHOR]

Endocrine and metabolic disorders can occur in the form of paraneoplastic syndrome and as a consequence of oncological treatment. The most common disorders include hypercalcaemia, ectopic production of vasopressin in the course of cancer, ectopic Cushing's syndrome and secondary osteoporosis. What should be taken into account during the diagnosis of endocrine disorders, is paraneoplastic syndrome that frequently precedes the occurrence of symptoms typical of a particular diagnosis, which could influence the proper orientation of the diagnostic process. During and after anticancer treatment, it is recommended that patients should be monitored for the possible development of acute or chronic metabolic and endocrine disorders which may pose a threat to their life or health. [ABSTRACT FROM AUTHOR]

Textile dyes effluents, which are disregarded as a result of the textile industry's disposal into the water systems, have been noted to have a potential role of aquatic life pollution including aquatic organisms, through causing alterations in the function of pituitary cells. These textile dyes are affecting the synthesis of sex steroid hormones which in return leads to endocrine disruption. The impact of some reactive textile dyes (RTDs) such as RY18 RB4 was investigated in this study against the health of Nile tilapia. Upon performing this study, results revealed that the alterations in the mRNA expression of some HPG-axis genes were observed in Nile tilapia exposed to RTDs compared to negative control and treated animals with H. atra. Such results then suggested that using H. atra as dietary supplements could reduce the adverse impacts of FSHβ, LHβ and CYP19A1 genes by RTDs, decreasing the incidence of endocrine disruptions in the Nile Tilapia. [ABSTRACT FROM AUTHOR]

Acanthosis nigricans (AN) is a velvety, hyperpigmentation of the skin that usually occurs in intertriginous areas. AN is most commonly associated with benign disorders like diabetes, insulin resistance, endocrinopathies and exogenous medications, but can be a valid cutaneous marker of a wide range of internal malignancies, which makes it important for the physicians across specialties to have awareness about it. With an increase in the prevalence of obesity and diabetes in recent decades, the prevalence of AN has also shown a significant increase. This article will review in detail the epidemiology, pathophysiology, clinical features and treatment of acanthosis nigricans in the light of the literature. [ABSTRACT FROM AUTHOR]

Background and purpose: Melkersson‐Rosenthal syndrome (MRS) is a rare neuro‐mucocutaneous disease. In addition to the traditional clinical triad, there is also a diversity of clinical signs, and it may be related to other systemic diseases. Methods: In the present study, we report a case of MRS with endocrine disorders that exhibits extraordinary therapeutic efficiency by using hydroxychloroquine (HCQ), explore whether there is an internal connection between MRS and endocrine disorders, and discuss the mechanism of the therapeutic efficiency of using HCQ. The hypothesis proposed for the first time is that MRS may essentially be a systemic granulomatous disease. Results: The physical examination revealed orofacial swelling and fissured tongue. The histopathologic examination showed epithelioid granulomas. Combined with the other examination, this case was diagnosed as incomplete MRS. HCQ and local drugs were introduced. The patient achieved clinical recovery and psychological cure by the 18‐week follow‐up, and the 1‐year follow‐up found no reactivation of MRS. Moreover, the levels of cortisol and adrenocorticotropic were within normal ranges. Conclusions: After the drug therapy was targeted at granuloma, not only did all of the symptoms related to MRS disappear, but the endocrine system also returned to normal. It is speculated that the endocrine disorder in this patient may be related to MRS. We further propose the first‐time hypothesis that MRS may essentially be a systemic granulomatous disease. It provides a new medication method with high‐level efficiency. [ABSTRACT FROM AUTHOR]

Background: Equine pituitary pars intermedia dysfunction, also known as equine Cushing's syndrome, is a neurodegenerative disease. An important risk factor for Cushing's is advanced aging and it is the most common endocrine disorder in older horses. The prevalence in horses aged over 10 and 15 years is reported as 9.3% and 21%, respectively. Due to the slow progressive nature of the disease, seasonal variation in hormone output and overlapping endocrine response to other events, accurate diagnosis is challenging. The diagnosis requires the combination of anamnesis, clinical signs, in addition to laboratory tests results. This study aimed to report Cushing's syndrome in a Crioulo breed horse focusing on diagnostic methods. Case: A 13-year-old male Crioulo breed, orchiectomized, was attended at the Universidade de Passo Fundo (UPF), in Passo Fundo, RS, Brazil. The owner reported that the animal had progressive weight loss and coat abnormal growth, with curly appearance. From visual inspection, body condition score was 4 (1-9) bulging abdomen was noticed, hirsutism, depression and lethargy. Also, there was a large neoplastic mass on the left side of gluteal region. Later, this mass was classified in histopathological examination as a fibroblastic sarcoid and was treated. The animal presented physical parameters within the physiological limits of the specie. Normochromic normocytic anemia and neutrophilic leukocytosis were reported in the hematologic evaluation. In coproparasitological examination, there were 300 eggs per gram of feaces. Hyperadrenocorticism was suspected in the clinical examination and dexamethasone suppression test was performed to confirm the fact. Basal serum was collected at 17 h (M0) and subsequently 40 µg/kg of dexamethasone was administered intramuscularly. Serum samples were taken after 15 (M15) and 19 (M19) h, resulting in cortisol levels of 1.7 and 1.8 µg/dL, respectively. The M15 and M19 results were above reference values for horses (below 1 µg/dL). Combination of information gathered from anamnesis, clinical examination and dexamethasone suppression test resulted in the definitive diagnosis of hyperadrenocorticism, also known as Cushing's syndrome. Paliative treatment included shearing all over the body and vitamin supplementation. Discussion: In animals without obvious clinical signs, Cushing's syndrome diagnosis is challenging. The most unique and specific clinical signs are the development of abnormal hair coat, mainly hirsutism, delayed or incomplete shedding, and in aged horse, lightening of coat color. The mechanistic cause of these signs is still barely understood. Cushing's is a collection of syndromes each with a unique set of clinical signs and hormone profiles, which varies according to each individual. Complementary examinations are extremely important and endocrine tests are highly recommended in addition to suggestive findings. However, despite the variety of existing tests, false negatives or false positives can frequently happen. Dexamethasone suppression test is considered the gold standard, well validated, practical and low cost for the diagnosis of this disease. In the present report, the combination of anamnesis (13 years old, weight loss, and abnormal coat), clinical exam (hirsutism) and dexamethasone suppression test (over 1 µg/dL of cortisol 15 h and 19 h after dexamethasone administration) resulted in the definitive diagnosis of Cushing's syndrome. Measurements of plasma concentrations of cortisol and adrenocorticotropic hormone (ACTH), thyrotropin releasing hormone (TRH) stimulation test, serum insulin concentration and necropsy are other available tests. History, clinical signs and test results are important to achieve the definitive diagnoses, and when possible, it is advisable to perform post mortem evaluation of the pituitary gland. [ABSTRACT FROM AUTHOR]

Background: Liquid chromatography-tandem mass spectrometry (LC-MS/MS)-based assays are employed in more and more clinical laboratories to quantify steroids. The steroid quantification by LC-MS/MS shows great value in screening or diagnosing endocrine disorders; however, the number of functional steroids included in the LC-MS/MS methods is still limited. Methods: Here, we describe the performance and validation of a 20-steroid plasma panel by LC-MS/MS. The panel included progestogens (including mineralocorticoids and glucocorticoids), androgens and estrogens biosynthesized in steroid metabolic pathways. The LC-MS/MS method was validated according to guidance documents, and subsequently employed to profile steroid changes in endocrine disorders. Results: Using LC-MS/MS, 20 steroids were separated and quantified in 8 min. Coefficients of variation (CVs) of the 20 analytes at the lower limit of quantification (LLoQ) were all less than 15% (ranging from 1.84% to 14.96%). The linearity of the assay was demonstrated by all the R2 values greater than 0.995. Individual plasma steroids changed significantly in patients with subclinical Cushing's syndrome (SCS) and polycystic ovary syndrome (PCOS) – 17-hydroxypregnenolone (17-OH-PR), testosterone (T) and dihydrotestosterone (DHT) were significantly decreased in SCS patients, while in PCOS patients, pregnenolone, corticosterone (CORT), androstenedione (A4) and T were significantly increased and DHT was decreased. Conclusions: The LC-MS/MS method we developed for the quantification of 20 plasma steroids is clinical practicable. The steroid profiling data using this assay indicate its screening value for endocrine disorders. To further explore the value of the assay, more investigations are however needed. [ABSTRACT FROM AUTHOR]

Background: endocrine disorders may affect sexuality due to hormonal changes, associated comorbidities and psychosocial impact. This topic remains poorly researched from the perspective of people with these conditions. Objectives: a qualitative research was conducted to understand the sexual experiences of women and men living with endocrine disorders that change their physical appearance. Methods: an analytical-interpretive study was carried out with a sample of 68 participants aged between 20 and 45, and treated at the National Institute of Endocrinology, Havana, Cuba. Data collection instruments were a personal information sheet, an in-depth interview guide and two projective psychological tests. Ethical aspects were considered. Results: in-depth interviews gave rise to four topics: 1) multidimensional expression of the disease, 2) the disease and life areas, 3) sexuality with the disease, and 4) coping strategies in the sexual area. These topics were linked to the meanings of health, body, gender and sexuality. Conclusions: the participants contextualized their sexual experiences within the biopsychosocial impact of the endocrine disorder, as well as the reproduction or questioning of the meanings that influenced the quality of their sexual experiences. The study showed that sexuality is a vulnerable area for the participants' comprehensive health. [ABSTRACT FROM AUTHOR]

A complete examination of the oral cavity is a neglected part of physical examination and is not taught in both undergraduate and postgraduate medical training. We believe that a thorough oral examination helps in the identification of a variety of endocrine disorders and so to emphasize this, we have proposed the term "orocrinolgy." Orocrinology is the art of using a Thorough oral cavity examination to diagnose a variety of adult and pediatric endocrine disorders. Under "orocrinology," we have highlighted an easy to perform a seven-step technique to perform a complete examination of the oral cavity. The common endocrine-related abnormalities that you might encounter during each of these seven steps is summarized along with the steps. The seven steps start with the examination of the salivary glands, followed by the lips. This is followed by the examination of labial, buccal, alveolar, and gingival mucosa in two steps. The fifth step is the Inspection of the tongue and the base of the mouth followed by the sixth step, which is the evaluation of the palate, uvula, and tonsils. The final seventh step is the examination of the hard structures in the oral cavity, which includes the teeth, mandible, and the maxilla. [ABSTRACT FROM AUTHOR]

Background: Endocrine disorders in patients after heart transplantation (HT) remain understudied. We aimed to assess endocrine profiles and management of HT recipients in the early post- transplant period. Methods: We conducted a retrospective cohort study on 123 consecutive HT recipients in the Advanced Heart Failure and Transplantation Programme between 2009 and 2018. All recipients had per-protocol endocrine follow-up within the first postoperative year. The median time to first post-transplant endocrine follow-up was 3 months (IQR 2–4). We assessed the incidence of vitamin D deficiency, bone mineral density, history of low energy fractures, hypogonadism in male recipients, posttransplant diabetes mellitus, and thyroid and parathyroid function. Results: We enrolled 22 women and 101 men of median age 57 years (IQR 50–63). Post-transplant diabetes mellitus developed in 14 patients (11.4%). 18 of 25 patients (14.6%) with preexisting type 2 diabetes mellitus required intensification of antidiabetic therapy. 38 male patients (40.4%) had hypogonadism. 5 patients (4.6%) were hypothyroid and 10 (9.3%) latent hyperthyroid. Secondary hyperparathyroidism was present in 19 (17.3%), 25-hydroxyvitamin D deficiency in 64 (54.7%) of patients. Osteoporosis was present in 26 (21.1%), osteopenia in 59 (48.0%) patients. 47 vertebral fractures, 3 hip and 1 humerus fractures occurred in 21 patients. Most of the patients had coincidence of two or three disorders, while less than 5% did not have any endocrine irregularities. All patients received calcium and vitamin D supplements. Forty-six patients (37.4%) were treated with zoledronic acid, 12 (9.8%) with oral bisphosphonates. Two patients were treated with teriparatide. Conclusions: The prevalence of multiple endocrine disorders early after heart transplantation is high. Assessment and management of increased fracture risk and all other potentially affected endocrine axes should be considered as a standard of care in this early period. [ABSTRACT FROM AUTHOR]

Cadmium (Cd) has been associated with several physiological problems including reproductive and endocrine system dysfunction resulting in temporary infertility. The principal objective of this project was to investigate the effects of prepubertal exposure to toxic doses of Cd on puberty onset, the endocrine system, and follicular development. For this purpose, 16 female Sprague-Dawley rats weaned on postnatal day (PND) 21 were randomly divided into 4 groups (n = 4 per group). The treatments were as follows: 0, 25, 50, and 75 mg/kg/day of cadmium chloride (CdCl2) by oral gavage from PND 21 to observation of first vaginal opening (VO). The results demonstrated that prepubertal exposure to different doses of CdCl2 delays the age of VO, first diestrus, and first proestrus via altering the concentrations of estradiol and progesterone. The low level of these steroid hormones contributed to lower differentiation and maturation of follicles and it finally led to reduced ovarian reservoir of follicles and impaired follicular development. The number of atretic follicles and secondary follicles with premature cavity increased in rats that received a high dose of CdCl2, whereas the number of secondary follicles and corpora luteum decreased in the same circumstances. Taken together, these data suggest that prepubertal exposure to toxic doses of Cd delays the onset of puberty via disorderliness in the concentration of steroid hormones and reduces the ovarian reservoir of follicles, as well as folliculogenesis. [ABSTRACT FROM AUTHOR]

L-glutamate, the major neurotransmitter in humans, becomes excitotoxic when present outside of protein in excess of what the healthy human was designed to accommodate; amounts readily available to consumers who ingest multiple free-glutamate-containing ingredients during a day. Studies have demonstrated that excitotoxins ingested by a mother will pass to the fetus across the placenta and pass to the newborn through mothers' milk. The purpose of this paper is to raise awareness of the relevance of glutamate from food additives such as MSG to human brain damage, and its possible contributions to glutamate toxicity in neurodegenerative diseases, stroke, autism, schizophrenia, depression, obsessive-compulsive disorder, epilepsy, seizures, addiction, attention-deficit/hyperactivity disorder, autism, headaches, asthma, diabetes, muscle pain, atrial fibrillation, ischemia, and trauma. [ABSTRACT FROM AUTHOR]

Background: Rare diseases (RD) result in a wide variety of clinical presentations, and this creates a significant diagnostic challenge for health care professionals. We hypothesized that there exist a set of consistent and shared phenomena among all individuals affected by (different) RD during the time before diagnosis is established. Objective: We aimed to identify commonalities between different RD and developed a machine learning diagnostic support tool for RD. Methods: 20 interviews with affected individuals with different RD, focusing on the time period before their diagnosis, were performed and qualitatively analyzed. Out of these pre-diagnostic experiences, we distilled key phenomena and created a questionnaire which was then distributed among individuals with the established diagnosis of i.) RD, ii.) other common non-rare diseases (NRO) iii.) common chronic diseases (CD), iv.), or psychosomatic/somatoform disorders (PSY). Finally, four combined single machine learning methods and a fusion algorithm were used to distinguish the different answer patterns of the questionnaires. Results: The questionnaire contained 53 questions. A total sum of 1763 questionnaires (758 RD, 149 CD, 48 PSY, 200 NRO, 34 healthy individuals and 574 not evaluable questionnaires) were collected. Based on 3 independent data sets the 10-fold stratified cross-validation method for the answer-pattern recognition resulted in sensitivity values of 88.9% to detect the answer pattern of a RD, 86.6% for NRO, 87.7% for CD and 84.2% for PSY. Conclusion: Despite the great diversity in presentation and pathogenesis of each RD, patients with RD share surprisingly similar pre-diagnosis experiences. Our questionnaire and data-mining based approach successfully detected unique patterns in groups of individuals affected by a broad range of different rare diseases. Therefore, these results indicate distinct patterns that may be used for diagnostic support in RD. [ABSTRACT FROM AUTHOR]

Several models for the long-term development of T2DM already exist, focusing on the dynamics of the interaction between glycemia, insulinemia and β-cell mass. Current models consider representative (fasting or daily average) glycemia and insulinemia as characterizing the compensation state of the subject at some instant in slow time. This implies that only these representative levels can be followed through time and that the role of fast glycemic oscillations is neglected. An improved model (DPM15) for the long-term progression of T2DM is proposed, introducing separate peripheral and hepatic (liver and kidney) insulin actions. The DPM15 model no longer uses near-equilibrium approximation to separate fast and slow time scales, but rather describes, at each step in slow time, a complete day in the life of the virtual subject in fast time. The model can thus represent both fasting and postprandial glycemic levels and describe the effect of interventions acting on insulin-enhanced tissue glucose disposal or on insulin-inhibited hepatic glucose output, as well as on insulin secretion and β-cell replicating ability. The model can simulate long-term variations of commonly used clinical indices (HOMA-B, HOMA-IR, insulinogenic index) as well as of Oral Glucose Tolerance or Euglycemic Hyperinsulinemic Clamp test results. The model has been calibrated against observational data from the Diabetes Prevention Program study: it shows good adaptation to observations as a function of very plausible values of the parameters describing the effect of such interventions as Placebo, Intensive LifeStyle and Metformin administration. [ABSTRACT FROM AUTHOR]

Background and aims: Many countries lack resources to identify patients at risk of developing Type 2 diabetes mellitus (diabetes). We aimed to develop and validate a diabetes risk score based on easily accessible clinical data. Methods: Prospective study including 5277 participants (55.0% women, 51.8±10.5 years) free of diabetes at baseline. Comparison with two other published diabetes risk scores (Balkau and Kahn clinical, respectively 5 and 8 variables) and validation on three cohorts (Europe, Iran and Mexico) was performed. Results: After a mean follow-up of 10.9 years, 405 participants (7.7%) developed diabetes. Our score was based on age, gender, waist circumference, diabetes family history, hypertension and physical activity. The area under the curve (AUC) was 0.772 for our score, vs. 0.748 (p<0.001) and 0.774 (p = 0.668) for the other two. Using a 13-point threshold, sensitivity, specificity, positive and negative predictive values (95% CI) of our score were 60.5 (55.5–65.3), 77.1 (75.8–78.2), 18.0 (16.0–20.1) and 95.9 (95.2–96.5) percent, respectively. Our score performed equally well or better than the other two in the Iranian [AUC 0.542 vs. 0.564 (p = 0.476) and 0.513 (p = 0.300)] and Mexican [AUC 0.791 vs. 0.672 (p<0.001) and 0.778 (p = 0.575)] cohorts. In the European cohort, it performed similarly to the Balkau score but worse than the Kahn clinical [AUC 0.788 vs. 0.793 (p = 0.091) and 0.816 (p<0.001)]. Diagnostic capacity of our score was better than the Balkau score and comparable to the Kahn clinical one. Conclusion: Our clinically-based score shows encouraging results compared to other scores and can be used in populations with differing diabetes prevalence. [ABSTRACT FROM AUTHOR]

Gastric emptying (GE) can be either delayed or accelerated in diabetes mellitus (DM). However, most research has focused on delayed GE mediated by a chronic hyperglycemic condition in DM. As such, the function of GE in the early stages of DM is not well understood. Interstitial cells of Cajal (ICC) are pacemaker cells in the gastrointestinal tract. In the present study, we investigated changes in GE and ICC networks in the early stages of DM using a streptozotocin-induced type 1 diabetic mouse model. The changes in GE were measured by the 13C-octanoic acid breath test. ICC networks were immunohistochemically detected by an antibody for c-Kit, a specific marker for ICC. Our results showed that GE in type 1 DM was significantly accelerated in the early stages of DM (2–4 weeks after onset). In addition, acute normalization of blood glucose levels by a single administration of insulin did not recover normal GE. ICC networks of the gastric antrum were significantly increased in DM and were not affected by the acute normalization of blood glucose. In conclusion, our results suggest that GE is accelerated in the early stages of DM, and it is associated with increased ICC networks. This mechanism may help to clarify a link between the onset of DM and GE disorders. [ABSTRACT FROM AUTHOR]

Purpose: To investigate if there are differences in macular capillaries between black and white subjects using optical coherence tomography angiography (OCTA) and identify potential factors underlying the epidemiologically-based higher vulnerability of black populations to diabetic retinopathy (DR). Methods: This prospective, observational cross-sectional study included 93 eyes of 47 healthy subjects with no medical history and ocular history who self-identified as black or white and were matched for age, sex, refractive error, and image quality. Subjects underwent OCTA imaging (RTVue-XR Avanti) of the superficial (SCP) and deep (DCP) capillary plexuses and choriocapillaris. AngioAnalytics was used to analyze vessel density (VD) and choriocapillaris % blood flow area (BFA) in the 1mm-diameter fovea, parafovea, and 3mm-diameter circular area including the fovea and parafovea (3x3mm image). Foveal avascular zone (FAZ) was also analyzed. Linear mixed models were used to evaluate for differences between the study groups. Results: Compared to the white subjects in this study, black subjects were found to have: lower foveal VD in the SCP (p<0.05); lower VD in the parafovea and in the 3x3mm image in the DCP (p<0.05); larger FAZ in SCP and DCP (p<0.05); and decreased choriocapillary BFA in the area underlying the fovea, parafovea, and 3x3mm image (p<0.05). Conclusion: In our study, our black subjects had decreased macular capillary vasculature compared to matched white subjects, even in early adulthood and the absence of any systemic or ocular conditions. To our knowledge, this is the first report showing that retinal and choriocapillary vascular differences may contribute to racial disparities in vulnerability to DR. [ABSTRACT FROM AUTHOR]

Recently, we observed a 15% decrease in the incidence of type 1 diabetes (T1D) in Australian 0-4-year-old children following the introduction of RV vaccination [[2], [3]], suggesting that RV vaccination could contribute to the primary prevention of this autoimmune disease. Australian surveillance data [[11]] show that the prevalence of RV G3 strains increased slightly along with an increase in strain diversity in the post-RV vaccine era, but G3 remains a minor component of disease-causing RV strains. RV was prevalent in nurseries, and the change to rooming-in would have altered the timing of exposure to RV, delaying it until later in the first year of life when, based on NOD mouse studies [[17]-[19]], RV might promote rather than retard development of diabetes. [Extracted from the article]

Background: Disparities in type 2 diabetes (T2D) care provision and clinical outcomes have been reported in the last 2 decades in the UK. Since then, a number of initiatives have attempted to address this imbalance. The aim was to evaluate contemporary data as to whether disparities exist in glycaemic control, monitoring, and prescribing in people with T2D.Methods and Findings: A T2D cohort was identified from the Royal College of General Practitioners Research and Surveillance Centre dataset: a nationally representative sample of 164 primary care practices (general practices) across England. Diabetes healthcare provision and glucose-lowering medication use between 1 January 2012 and 31 December 2016 were studied. Healthcare provision included annual HbA1c, renal function (estimated glomerular filtration rate [eGFR]), blood pressure (BP), retinopathy, and neuropathy testing. Variables potentially associated with disparity outcomes were assessed using mixed effects logistic and linear regression, adjusted for age, sex, ethnicity, and socioeconomic status (SES) using the Index of Multiple Deprivation (IMD), and nested using random effects within general practices. Ethnicity was defined using the Office for National Statistics ethnicity categories: White, Mixed, Asian, Black, and Other (including Arab people and other groups not classified elsewhere). From the primary care adult population (n = 1,238,909), we identified a cohort of 84,452 (5.29%) adults with T2D. The mean age of people with T2D in the included cohort at 31 December 2016 was 68.7 ± 12.6 years; 21,656 (43.9%) were female. The mean body mass index was 30.7 ± SD 6.4 kg/m2. The most deprived groups (IMD quintiles 1 and 2) showed poorer HbA1c than the least deprived (IMD quintile 5). People of Black ethnicity had worse HbA1c than those of White ethnicity. Asian individuals were less likely than White individuals to be prescribed insulin (odds ratio [OR] 0.86, 95% CI 0.79-0.95; p < 0.01), sodium-glucose cotransporter-2 (SGLT2) inhibitors (OR 0.68, 95% CI 0.58-0.79; p < 0.001), and glucagon-like peptide-1 (GLP-1) agonists (OR 0.37, 95% CI 0.31-0.44; p < 0.001). Black individuals were less likely than White individuals to be prescribed SGLT2 inhibitors (OR 0.50, 95% CI 0.39-0.65; p < 0.001) and GLP-1 agonists (OR 0.45, 95% CI 0.35-0.57; p < 0.001). Individuals in IMD quintile 5 were more likely than those in the other IMD quintiles to have annual testing for HbA1c, BP, eGFR, retinopathy, and neuropathy. Black individuals were less likely than White individuals to have annual testing for HbA1c (OR 0.89, 95% CI 0.79-0.99; p = 0.04) and retinopathy (OR 0.82, 95% CI 0.70-0.96; p = 0.011). Asian individuals were more likely than White individuals to have monitoring for HbA1c (OR 1.10, 95% CI 1.01-1.20; p = 0.023) and eGFR (OR 1.09, 95% CI 1.00-1.19; p = 0.048), but less likely for retinopathy (OR 0.88, 95% CI 0.79-0.97; p = 0.01) and neuropathy (OR 0.88, 95% CI 0.80-0.97; p = 0.01). The study is limited by the nature of being observational and defined using retrospectively collected data. Disparities in diabetes care may show regional variation, which was not part of this evaluation.Conclusions: Our findings suggest that disparity in glycaemic control, diabetes-related monitoring, and prescription of newer therapies remains a challenge in diabetes care. Both SES and ethnicity were important determinants of inequality. Disparities in glycaemic control and other areas of care may lead to higher rates of complications and adverse outcomes for some groups. [ABSTRACT FROM AUTHOR]

Background: The extent of medication adherence in patients with type 2 diabetes mellitus (T2DM) several years after starting treatment with hypoglycemic agents remains unknown. Most previous work on medication adherence targeting this group of patients has been undertaken across a single year or is questionnaire based. This study aimed to determine medication adherence status and factors affecting adherence 3 years after initiation of hypoglycemic agents, using a nationwide medical claim-based database in Japan. Methods: This retrospective study was conducted on data from 884 subjects with T2DM to better understand medication adherence, the effects of polypharmacy, and other factors. We also investigated the effects of medication nonadherence on hemoglobin A1c levels. Proportion of days covered was defined as the number of days for which a hypoglycemic agent was prescribed and in the patient’s possession to the number of days in the observation period. A proportion of days covered ≥0.8 were considered adherent, and those with a value <0.8 as nonadherence. Polypharmacy was defined as taking ≥5 medications. Results: Of the 884 patients investigated, 440 were considered adherent during the study period. Significant factors related to adherence included number of medications (3 or 4, or ≥5), male sex, age 50–<60 years, and total number of visits ≥17. Medication adherence was also a factor related to patients with hemoglobin A1c values < 7.0% at the end of the observation period. Conclusions: We surveyed medication adherence for 3 years with post medication initiation, and found that subjects aged 50–<60 years, those with ≥3 concomitant medications, and those with a total number of visits ≥17 were more likely to be adherent and persistent, and more likely to continue their hypoglycemic agents. A high degree of medication adherence was found to have a positive influence on hemoglobin A1c levels. [ABSTRACT FROM AUTHOR]

CD34+ cells maintain vascular homeostasis and predict cardiovascular outcomes. We previously evaluated the association of CD34+ cells with cardiovascular disease (CVD) events over 23 months, but long-term CVD outcomes in relation to levels of CD34+ cells in patients on maintenance hemodialysis are unclear. Herein, we analyzed the long-term predictive potential levels of CD34+ cells for CVD outcomes and all-cause mortality. Between March 2005 and May 2005, we enrolled 215 patients on maintenance hemodialysis at Nagoya Kyoritsu Hospital and followed them up to 12.8 years. According to the CD34+ cell counts, patients were classified into the lowest, medium, and highest tertiles. Levels of CD34+ cells were analyzed in association with four-point major adverse CV events (MACEs), CVD death, and all-cause mortality. In univariate analysis age, smoking habit, lower geriatric nutrition risk index, lower calcium × phosphate product, and lower intact parathyroid hormone were significantly associated with the lowest tertile. Whereas, in multivariate analysis, age and smoking habit were significantly associated with the lowest tertile. Among 139 (64.7%) patients who died during a mean follow-up period of 8.0 years, 39 (28.1%) patients died from CVD. Patients in the lowest tertile had a significantly lower survival rate than those in the medium and highest tertiles (p ≤ 0.001). Using multivariable analyses, the lowest tertile was significantly associated with four-point MACEs (hazard ratio 1.80, p = 0.023) and CVD death (hazard ratio 2.50, p = 0.011). In conclusion, our long-term observational study revealed that a low level of CD34+ cells in the circulation predicts CVD outcomes among patients on maintenance hemodialysis. [ABSTRACT FROM AUTHOR]

Noncommunicable diseases (NCDs) are a broad challenge for decision-makers. NCDs account for seven out of every 10 deaths globally, with 42 percent occurring prematurely in individuals under age 70. Despite their heavy toll, NCDs are underfunded, with only around two percent of global funding dedicated to the disease set. Country governments are responsible for funding targeted actions to reduce the NCD burden, but among other priorities, many have yet to invest in the health-system interventions and policy measures that can reduce the burden. This article examines “investment cases” as a potential mechanism for catalyzing attention to—and funding for—NCDs. In Jamaica, using the UN inter-agency OneHealth Tool, we conducted an economic analysis to estimate the return-on-investment from scaling up strategic clinical interventions, and from implementing or intensifying policy measures that target NCD risk factors. In addition, we conducted an institutional and context (ICA) analysis, interviewing stakeholders across sectors to take stock of promising policy pathways (e.g., areas of general consensus, political appetite and opportunity) as well as challenges to implementation. The economic analysis found that scaling up clinical interventions that target CVD, diabetes, and mental health disorders, and policy measures that target tobacco and alcohol use, would save over 6,600 lives between 2017–2032, and avert JMD 81.3 billion (USD 640 million) in direct and indirect economic costs that result from mortality and morbidity linked to NCDs. The ICA uncovered government economic growth targets and social priorities that would be aided by increased attention to NCDs, and it linked these targets and priorities to the economic analysis. [ABSTRACT FROM AUTHOR]

The profiles of polytraumatized patients in intensive care units were characterized. Serum and salivary markers were compared with normality between Classes I and II of APACHE II and between periods of hospitalization; these results were correlated. This was a prospective study on saliva charts and collection (n = 70). Profile: male, 27 years old, blunt traumas and collisions. Serum parameters with normality: decrease in pH, creatinine at admission to Class I, and at 48 and 72 hours in both classes; K+ at 48 h in Class II; Ca+ on admission in both classes and at 72 h in Class I. Increase in urea at 72 h in Class II, glucose at all times and in all classes, and Ca+ at 48 h in both classes. Class II had high Na+ at 48 and 72 h compared to Class I. In Class I, creatinine reduction occurred in 48 h and 72 h compared to admission and an increase of Ca+ at 48 h with admission. In Class II, pH and Na+ increased at 48 h and 72 h compared to admission. K+ decreased from admission to 48 h and increased from 48 h to 72 h. Urea increased from 48 to 72 hours. Creatinine decreased from admission to 48 and 72 hours. Ca+ increased from admission to 48 hours and decreased from 48 to 72 hours. There was an increase in the saliva levels in both classes and times in relation to normality. There was an increase in urea at admission, glucose at 72 h, and Ca+ at 48 h in Class II compared with Class I. Class I urea increased from admission to 48 h and Ca+ decreased from admission to 48 h. Class II urea decreased from 48 h to 72 h. Strong or very strong positive correlation was identified between blood and creatinine saliva at all times and regular and negative Ca+ at 72 h. This study provides evidence that salivary and serum biomarkers can be used together to monitor the evolution of the clinical symptoms of ICU patients. [ABSTRACT FROM AUTHOR]