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Gestational diabetes is one of the most common medical complications of pregnancy, and its prevalence is increasing worldwide. Although the HAPO study resulted in the diagnostic criteria of gestational diabetes of the international association of diabetes and pregnancy study groups, they are not yet accepted by all learned societies. Also, the cost-effectiveness of early gestational diabetes research remains to be determined. A new classification in four categories instead of two, has just been published in 2024 suggesting a promising prognostic interest. Despite the great popularity of metformin, its use in gestational diabetes remains controversial due to the transplacental passage and the lack of long-term follow-up data and insulin now remains the first-line treatment. Continuous glucose monitoring is a promising tool that certainly improves glycemic control, but its use in gestational diabetes, in particular patients not treated with insulin, suffers from a low level of evidence. [ABSTRACT FROM AUTHOR]

Background: Thyroid nodules (TN) are more frequent in the iodine-deficient region and the proportion of benign nodules is higher compared to areas with sufficient iodine intake. Objective: The aim of this study was to assess factors associated with malignant TN specially the EU-TIRADS ultrasound score in a Moroccan population with a high prevalence of iodine deficiency. Methods: In a prospective cross-sectional study, we enrolled outpatients referred for TN with fine needle aspiration biopsy (FNAB) according to EU-TIRADS 2017 classification. Malignancy of TN was defined by histological results indicating a thyroid malignancy on thyroid micro-biopsy or after surgical resection if indicated. Results: 225 participants with TN were enrolled. The median age was 54 (42.5 to 62) years-old. The prevalence of malignant TN was 8.9%. Malignant TN were significantly smaller than non-malignant ones (p = 0.008) and sub-centimetric TN were more frequent in malignant TN (25% vs 1.5%; p < 0.001). On multivariate analysis, male gender (OR : 9.33 ; 95% CI [2.02 ; 43.01]; p = 0,004) and EU-TIRADS score of 5 (OR : 55.6 ; 95% CI [9.34 ; 327.91] ; p < 0.001) were independent factors associated with malignant TN. The EU-TIRADS score of 4 was not associated to malignant TN. Conclusion: Our data suggest a trend of over-diagnosing indolent thyroid cancer. The EU-TIRADS score of 4 was not associated with TN malignancy. Considering clinical, accessory sonographic features, and size threshold for FNAB in EU-TIRADS 4 score TN may refine the diagnosis performance of this score in our population [ABSTRACT FROM AUTHOR]

Coronary spasm related to thyrotoxicosis is a complication rarely reported in the literature. Its initial clinical presentation is often more severe with more diffuse involvement and resistance to medical treatment compared to classic coronary spasm. Its diagnosis relies on a careful clinical analysis and a comparative study of electrocardiographic data. Coronary angiography should be avoided as much as possible as well as treatment by nonselective beta-blocking agents because of the risk of worsening hyperthyroidism and coronary vasoconstriction. We report a case of coronary spasm secondary to Graves' disease whose management was inspired by lessons learned from clinical cases reported in the literature. [ABSTRACT FROM AUTHOR]

Copyright of Cahiers Santé - Médecine Thérapeutique is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

INTRODUCTION: Coronary artery disease (CAD) is a cause of death in 75% of patients with diabetes. Its often asymptomatic nature delays diagnosis. In aeronautics, it can cause in-flight incapacitation, beyond which it represents a major fear for the medical expert. Screening for CAD is still a topical subject with the advent of new cardiovascular (CV) risk biomarkers and more effective screening tests. We report the experience of the Aeromedical Expertise Center of Rabat in this screening of diabetic pilots, with a recommendations review. METHODS: A prospective study over 1yr included diabetic pilots who benefited from systematic screening for CAD after a CV risk stratification. Coronary angiography is performed if a screening test is positive. Subsequent follow-up is carried out in consultation with the attending physician with regular evaluation in our center. RESULTS: There were 38 pilots included in our study. The average age was 55 ± 4.19yr and about 73% had a high CV risk. CAD was detected in 4 cases (10.52%) who had abnormal resting electrocardiograms and required revascularization with the placement of active stents. Approximately 75% of pilots with CAD returned to fly through a waiver with restrictions. DISCUSSION: Screening for coronary disease in diabetics is controversial, and current recommendations are not unanimous. In our study, the screening did not identify coronary diabetic pilots who could benefit from bypass surgery. Nevertheless, coronary disease was diagnosed, justifying grounding to preserve flight safety, which is an absolute priority in aviation medicine. [ABSTRACT FROM AUTHOR]

Metformin is one of the prevalent treatments for type 2 diabetes. It is widely used in diabetology due to its safety and effectiveness. For more than a decade, there was a growing interest on the benefit of metformin in multiple tumor locations, especially in the breast cancer. Epidemiological data shows a reduced incidence of breast cancer in patients on metformin. The underlying mechanism of this benefic effect could be the limitation of tumor cell proliferation by downregulating the insulin/IGF-1 axis and phosphorylation of mTOR. However, the available data are not sufficient to support the use of metformin in breast cancer as an anti-tumor therapy. Ongoing trials are evaluating the benefit of metformin in different stages of breast cancer. Additional researches including potential biomarkers are needed to confirm the accurate efficacy of metformin treatment in the prevention and the recurrence of breast cancer. [ABSTRACT FROM AUTHOR]

Copyright of Cahiers Santé - Médecine Thérapeutique is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: The aim of this study was to estimate the prevalence of cardiovascular disease and investigate cardiovascular risk management among type 2 diabetes (T2D) patients in the city of Meknes. Materials and methods: In a non-interventional cross-sectional study, we enrolled adult outpatients (= 18 years old) with T2D from the endocrinology and diabetology consultation of the Military Hospital of Meknes from June 2021 to January 2022. Informed consent was signed by all participants in the study. Assessment of cardiovascular risk was based on European Society of Cardiology (ESC) Guidelines on cardiovascular disease prevention in clinical practice of 2021. Clinical, biological and therapeutic data were compared between patients with and without cardiovascular disease. Data were analyzed using SPSS version 18 statistical software. Results: One hundred eighty T2D patients were enrolled. The mean age was 59.42 ± 8.72 years. The prevalence of cardiovascular disease was 13.3%. The prescription of statin (p < 0.001), antihypertensive treatment (p < 0.001) and platelet aggregation inhibitors (p < 0.001) was significantly higher in patients with cardiovascular disease. Overall, 5.6% patients were prescribed a blood glucose-lowering agent with demonstrated cardiovascular benefit. This prescription was higher in patients with cardiovascular disease (5 (20.8%) vs. 5 (3.2%); p = 0.004). It was found that 7.2% patients had an optimal cardiovascular risk factor management. Conclusions: The prevalence of cardiovascular disease among T2D patients is high in the city of Meknes. Despite an optimal prescription of cardiovascular medications, comprehensive control of cardiovascular risk factors is not achieved in most patients. The use of blood glucose-lowering agents with demonstrated cardiovascular benefit was low but significantly higher among patients with cardiovascular disease. [ABSTRACT FROM AUTHOR]

Bilateral macronodular adrenal hyperplasia (BMAH) is a rare cause of adrenal Cushing's syndrome, accounting for less than 1% of cases. We here report the case of a 48-year-old patient with diabetes and hypertension presenting with clinical signs of Cushing's syndrome. Etiological assessment enabled clinicians to retain the diagnosis of Adrenocorticotropic hormone (ACTH)-independent hypercortisolism associated with BMAH. Unilateral left adrenalectomy was performed based on noriodocholesterol scintigraphy results, with good outcome. However, given the risk of recurrence and cardiovascular complications, long-term monitoring was scheduled. [ABSTRACT FROM AUTHOR]

Autoimmune hypothyroidism is a common medical condition. Its revelation by thyrotrophic hyperplasia is an unusual and may be misdiagnosed as a pituitary adenoma. A 35-year-old man is referred to us for endocrinological assessment before surgery of a pituitary macroadenoma with bitemporal hemianopsia. Biological data reveal profound primary hypothyroidism. With thyroid hormone substitution, the thyroid function was normalized. Follow-up magnetic resonance imaging, showed the complete shrinkage of the pituitary mass attesting of a thyrotrophic pituitary hyperplasia. This case highlights the importance of a multidisciplinary assessment of pituitary masses to avoid unnecessary surgery and to prevent consequences of sellar masses. [ABSTRACT FROM AUTHOR]

Introduction: Chronic kidney failure is an independent risk factor of cardiovascular disease. Its association with carotid atherosclerosis remains controversial. The purpose of our study was to assess the factors associated with carotid atherosclerosis specially the components of chronic kidney disease., Methods: In a cross-sectional study, we enrolled type 1 or type 2 diabetic patients from the endocrinology an diabetology department of the military hospital of Rabat assigned in two groups according to the presence or absence of carotid atherosclerosis. Kidney function was assessed based on albuminuria and the estimated glomerular filtration rate calculated using the "modification of diet in renal disease" equation. A multiple logistic regression analysis was performed to identify independent factors associated with carotid atherosclerosis., Results: One hundred and six diabetic patients were enrolled including 96 type 2 diabetic patients. Age (P<0.001), diabetes duration (P=0.04), hypertension (P=0.002), peripheral arterial disease (P<0.001) and chronic kidney failure (P=0.001) were significantly associated with carotid atherosclerosis. After adjusting for age, hypertension, diabetes duration and peripheral arterial disease, chronic kidney failure was an independent factor associated with carotid atherosclerosis (OR: 5.46; 95%IC: 1.29-23.01; P=0.021)., Conclusion: Our data suggest that chronic kidney failure is associated with carotid atherosclerosis in diabetic patients independently of the common cardiovascular risk factors., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)