Fluctuations In Serum Levels Research Articles

The global prevalence of sexual dysfunction in men with thyroid gland disorders: a systematic review and meta-analysis.

fluctuation in serum levels of thyroid hormones or thyroid-associated dysfunction can negatively affect the sexual behaviors or performance, and disruption in couples` relationship or satisfaction. Thus, this systematic review and meta-analysis study was aimed to investigate the global prevalence of sexual dysfunction in men with thyroid gland disorders (TGD). this systematic review and meta-analysis study conducted based on PRISMA statement criteria regarding the available evidences representing the prevalence of sexual dysfunction in men with TGD. The initial searching process was applied on July, 2023. In this era, the main keywords of "Prevalence", "Sexual disorders", "Sexual disorder", "Sexual dysfunction", "Male sexual dysfunction", "Erectile dysfunction", "Males", "Men", "Thyroid disorders", "Thyroid diseases", "Hyperthyroidism", "Thyroid", and "Thyroiditis" were hired. Also, "AND" and "OR" operators were used for keywords combination. All intended studies were searched using the databases of Web of Science, Google Scholar, Scopus, ScienceDirect, PubMed, and Embase. Random effects model was used to perform the analysis and the heterogeneity of the studies was assessed through I2 index. Data analysis was applied with CMA software (v.2). following the assessment of 17 eligible studies with a sample size of 501 individuals, the global prevalence of male sexual dysfunction with TGD was found 51.5% (95% CI:38.7-64). Also, the prevalence of male sexual dysfunction in hypothyroidism and hyperthyroidism cases was 59.1% (95% CI:37.2-77.8) and 41.5% (95% CI:25.9-59.1), respectively. The meta-regression analysis showed that following incremental trend in sample size, the global prevalence of male sexual dysfunction with TGD decreases. This assessment also revealed that the prevalence of male sexual dysfunction increases with the year of study conduction, significantly (p < 0.05). the global prevalence of sexual dysfunction in men with TGD was found relatively high. also, the highest prevalence of sexual disorders was reported in hypothyroid cases. Thus, health policymakers are suggested to inform the individuals prone to this pathology regarding the negative effects of TGD on sexual dysfunction. Besides, TGD-affected cases can prevent sexual disorders and unpleasant consequences through timely medical treatments.

Establishment of cell-lines stably expressing recombinant Japanese eel follicle-stimulating hormone and luteinizing hormone using CHO-DG44 cells: fully induced ovarian development at different modes.

The gonadotropins (Gth), follicle-stimulating hormone (Fsh) and luteinizing hormone (Lh), play central roles in gametogenesis in vertebrates. However, available information on their differential actions in teleost, especially in vivo, is insufficient. In this study, we established stable CHO-DG44 cell lines expressing long-lasting recombinant Japanese eel Fsh and Lh with extra O-glycosylation sites (Fsh-hCTP and Lh-hCTP), which were produced in abundance. Immature female eels received weekly intraperitoneal injections of Gths. Fsh-hCTP induced the entire ovarian development by 8 weeks from the beginning of injection; thus, the ovaries of most fish were at the migratory nucleus stage while the same stage was observed in eels after 4 weeks in the Lh-hCTP-treated group. In contrast, all pretreated and saline-injected eels were in the pre-vitellogenic stage. Gonadosomatic indices in the Fsh-hCTP-treated group were significantly higher than those in the Lh-hCTP group at the migratory nucleus stage because of the significantly higher frequency of advanced ovarian follicles. Ovarian mRNA levels of genes related to E2 production (cyp11a1, cyp17a1, cyp19a1, hsd3b, fshr, and lhr) were measured using real-time quantitative reverse transcription-polymerase chain reaction (RT-PCR). All genes were induced by both Fsh-hCTP and Lh-hCTP, with a peak at either the mid- or late vitellogenic stages. Transcript abundance of cyp19a1 and fshr in the Lh-hCTP group were significantly higher than those in the Fsh-hCTP group, whereas no difference in the expression of other genes was observed between the groups. Fluctuations in serum levels of sex steroid hormones (estradiol-17β, 11-ketotestosterone, and testosterone) in female eels were comparable in the Fsh-hCTP and Lh-hCTP groups, thus increasing toward the maturational phase. Furthermore, the fecundity of the eels induced to mature by Fsh-hCTP was significantly higher than that induced by Lh-hCTP. These findings indicate that Fsh and Lh can induce ovarian development in distinctively different modes in the Japanese eel.

Pharmacogenetic variants of CYP2C9 and CYP2C19 associated with adverse reactions induced by antiepileptic drugs used in Peru

Epilepsy is the most common neurological disorder with a worldwide incidence of 20% and a treatment failure rate of 25–30%. The fluctuation in serum levels, efficacy and safety of antiepileptic drugs can be attributed to single nucleotide polymorphisms of genes encoding their respective proteins involved in drug metabolism. The present study attempted to evaluate the pharmacogenetic variants of CYP2C9 and CYP2C19 associated with adverse reactions induced by antiepileptic drugs used in Peru. Few studies were found to significantly associate the CYP2C9*2, CYP2C9*3, CYP2C19*2, and CYP2C19*3 single nucleotide polymorphisms with elevated serum levels of valproic acid and carbamazepine, and valproic acid induction of hyperammonemia, and adverse reactions cutaneous for carbamazepine. There is further evidence of a significant association of CYP2C9*2/CYP2C9*3 with severe cutaneous adverse reactions (SCARs) such as Stevens-Johnson syndrome (SJS) and epidermal necrolysis (TEN) phenytoin-induced. CYP2C9*3 may be a pharmacogenetic biomarker for such a drug. It is proposed to reduce the dose of drugs for intermediate and poor metabolizers. No pharmacogenetic studies were found in patients with epilepsy in Peruvian populations. It is concluded that this review could help physicians in the prediction and prevention of adverse reactions induced by antiepileptic drugs, as well as to improve their pharmacotherapeutic results. It could also be used as scientific evidence to carry out pharmacogenetic and precision medicine studies in Peruvian patients with epilepsy, due to their tricontinental and Latin American ancestry.

Antibiotic Optimization in the Intensive Care Unit.

Effective antimicrobial therapy remains paramount to successful treatment of patients with critical illness, such as pneumonia and sepsis. Unfortunately, critically ill patients often exhibit altered pharmacokinetics and pharmacodynamics (PK/PD) that make this endeavor challenging. Particularly in sepsis, alterations in volume of distribution (Vd) and protein binding lead to unpredictable effects on serum levels of various antimicrobials. Additionally, metabolic pathways and excretion may be significantly impacted due to end-organ failure. These dynamic factors may increase the likelihood of deleterious effects such as treatment failure or toxicity. Meeting these challenging scenarios has led to various strategies meant to improve clinical cure without untoward consequences. Vancomycin and β-lactam antimicrobials are frequently utilized and have been the focus of dose optimization strategies including extended infusion (EI) or continuous infusion (CI). Available data suggests that administration of vancomycin by CI may reduce the risk of nephrotoxicity without increasing the risk of treatment failure, although retrospective data are largely utilized in supporting this method. Other efforts to optimize vancomycin have focused on transitioning from trough-based therapeutic drug monitoring (TDM) to area-under-the-curve: minimum inhibitory concentration (AUC:MIC) ratios. Despite the creation of more user-friendly methods of calculation and data suggesting reduced rates of nephrotoxicity, widespread implementation is limited, in part due to clinician comfort. Use of β-lactams in patients with sepsis is similarly problematic due to observational data demonstrating fluctuations in serum levels in the setting of critical illness. Implementing TDM of agents such as piperacillin-tazobactam, cefepime, and meropenem has been suggested as a method of improving time above MIC (T >MIC). This practice is limited by the lack of access to commercial assays and the failure of rigorous studies to demonstrate improved treatment success. Clinicians should be aware of these challenges and should refine their dosing strategies based on individualized patient factors to reduce treatment failure.

Variety of Cardiac Events in Hospitalized Chronic Kidney Disease Patients.

ObjectiveThis study assessed the variety and frequency of various cardiovascular events in different stages of chronic kidney disease (CKD) patients who were hospitalized due to different causes.MethodsThis prospective cross-sectional observational analysis was conducted at the Department of Nephrology in The Kidney Centre Post Graduate Training Institute Karachi on all adult CKD (of all stages with or without dialysis) patients, who developed cardiovascular events during their hospital admission either in ward or ICU due to any cause between August 2020 and February 2021. Total of 765 patients got admitted in the given time period and among them, 290 patients developed various cardiovascular events. Baseline data, co-morbidities, clinical features, drug history and management were determined.ResultsThere were a total of 290 patients in our study in which 154 (53.1%) were male and 136(46.9%) were female. Mean age was 57 ± 15.5. Our majority of patients were end-stage renal disease and on maintenance hemodialysis (n=119, 41%) while the most prevalent co-morbid condition was hypertension (n=227, 78.3%) followed by diabetes mellitus (n=204, 70.4%). The most frequent cardiovascular events in CKD patients was the atrial fibrillation 101(34.8%) while 37(12.8%) patients suffered ST-elevation myocardial infarction and supraventricular tachycardia. Patients who had high potassium levels (>5.2) most frequently suffered from atrial fibrillation (n=16, 28.1%) as compared to other cardiovascular events.ConclusionPatients with CKD are at increased risk of having several cardiovascular events. Numerous risk factors involved in the pathogenesis. Among the diverse causes, fluctuations in serum levels of various electrolytes are important causes as certain electrolytes disbalance can trigger various life-threatening cardiac arrhythmias.

Seasonal fluctuations in serum levels of vitamin D in Japanese patients with multiple sclerosis

We explored the presence of seasonal fluctuations in serum vitamin D levels and potential relationship between vitamin D levels and disease severity or prognosis in patients with multiple sclerosis (MS) in northern Japan. Serum levels of 25(OH)D in spring were significantly lower than in summer and autumn, whereas no differences in 1,25(OH)2D levels were demonstrated among four seasons. Seasonal fluctuations in 25(OH)D were demonstrated in patients with EDSS ≤3.5, but not in those with EDSS≥4.0. Negative correlations between 25(OH)D and EDSS or MSSS were found in each season. Seasonal fluctuations in 25(OH)D levels may be affected by physical disabilities.

Seasonal variations in serum levels of vitamin D and other biochemical markers among KSA patients prior to thyroid surgery

ObjectivesSerum levels of vitamin D can vary between seasons, which may affect serum calcium levels in post-thyroidectomy patients. This study aimed to determine seasonal variations in serum levels of vitamin D and other biochemical markers in patients prior to thyroid surgery in a KSA hospital. MethodsIn this study, we analysed the data of 685 post-thyroidectomy patients. The preoperative laboratory values of all patients were collected, and the patients were categorized into groups based on the month when the surgical procedure was performed as follows: cold (November–February) and warm/hot groups (March–October). ResultsSerum vitamin D levels were deficient in 70% of the patients, insufficient in 18%, and optimal in 12%. The mean age of patients in the deficient group was significantly lower than that in the optimal group. There were significantly more patients who had vitamin D deficiency during the cold season than during the warm/hot season (p = 0.024). Serum vitamin D levels did not vary between seasons (p = 0.836); however, the preoperative magnesium and thyroid stimulating hormone (TSH) levels were significantly higher during the warm/hot season than during the cold season (p = 0.039 and p < 0.001, respectively). Preoperative calcium level was not significantly different between the cold and warm/hot months (p = 0.282). ConclusionThis study suggests a non-significant seasonal fluctuation in serum levels of vitamin D with insignificant variation in serum calcium levels during cold and warm/hot seasons. The findings necessitate a careful review of the patients’ biochemical status prior to surgery. Future prospective longitudinal studies are needed to confirm this variability.

Fluctuations in serum levels of adalimumab and infliximab in patients on stable treatment for psoriasis.

Many patients with psoriasis fail to respond to biologic drugs either initially or lose response over time, the latter having predominantly been linked to low circulating drug levels. We examined how serum drug levels varied over three treatment cycles of stable maintenance therapy with either adalimumab or infliximab among a total of 28 patients with psoriasis (22 men, mean age 48.6 years, mean treatment time 6.2 years) and whether there was an association with various patient-specific factors. The range for all concentrations was 1.1 to 24.3 μg/mL for adalimumab and 0.0 to 180.6 μg/mL for infliximab. There was a consistent inverse association between body mass index (BMI) and trough and maximum serum concentrations of adalimumab (P < .05 for all comparisons) and a positive, less consistent, association between age and maximum serum concentration of infliximab (P < .05 for both comparisons). Patient-specific factors, such as BMI and age, can help predict fluctuations in serum concentrations of biologics used for psoriasis.

Analyzing the Abundance of the Gene glmM in Subjects with a Positive Helicobacter pylori Stool Antigen Test (HPSA) and Correlating glmM Abundance with Serum Levels of Cytokines TNF-α and IL-1β

Introduction: One of the most common genes in Helicobacter pylori is glmM which is usually used for identification of infection with the bacterium within gastric biopsy specimens by PCR, as a target gene. The aim of this study was to examine the prevalence rate of glmM gene in DNA samples of stool and evaluate its relationship with the fluctuations of serum levels of TNF-α and IL- 1β. Materials & methods: In this study, blood and stool samples were collected from 82 subjects in two groups with positive and negative HPSA test referred to laboratories of Ilam, Iran. PCR was used to investigate the presence of glmM gene in DNA extracted from stool samples, and then serum levels of studied cytokines were measured using specific kits by ELISA, and the results were analyzed using statistical tests. Findings: Analysis of data obtained from the study showed that the frequency of glmM gene in the sample of cases with positive HPSA was 23.8%, and there was a significant relationship between the presence of this gene in stool and fluctuations in serum levels of TNF-α and IL- 1β (P less-than 0.05). Disussion & conclusion: According to data, it can be said that the presence of glmM gene was associated with fluctuations in any of the variables of HPSA, TNF-α and IL- 1β and the possible presence of the gene in the stool raises with increase in each unit of HPSA and IL- 1β, which in turn raises the prognosis of diseases with a virulence form of bacteria by both serology and stool methods.

Prognostic values of fluctuations in serum levels of alanine transaminase in inactive carrier state of HBV infection.

Background:Current guidelines introduce periodic monitoring of serum alanine transaminase (ALT) as the first-line modality in follow-up patients, with a hepatitis B virus (HBV) inactive carrier state.Objectives:This study aimed to determine the incidence rate and patterns of ALT fluctuations and prognostic values for the development of chronic HBV e antigen (HBeAg)-negative hepatitis B (CHB), HBV surface antigen (HBsAg) seroclearance, and liver-related complications.Patients and Methods:Treatment-naïve patients with a chronic HBV infection, HBeAg(-)/HBeAb(+), normal ALT levels, and HBV DNA < 2000 IU/mL, were followed-up every 6-12 months by assessing serum ALT levels. Serum HBV DNA was measured in cases of elevated ALT levels.Results:A total of 399 patients were followed-up for 8.9 years; ALT > upper limit of normal (ULN, i.e. 40 IU/L) was detected in 103 (25.8%) patients, with an annual incidence rate of 2.9%. ALT elevation was associated with; male gender, age, and higher serum ALT levels at study entry. Among the cases of ALT elevations, 16 (15.5%) patients had ALT levels > 2 × ULN. There were 38 (36.9%) patients who had ALT levels that remained > ULN over six months, and 21 (20.4%) patients experienced at least two episodes of ALT elevations. In 15 (14.6%) patients, elevated ALT levels were associated with increased HBV replication (i.e. HBV DNA > 2 000 IU/mL) and these were considered as CHB. However, elevation of ALT levels, even in the absence of HBV replication, increased the risk for the development of CHB up to 8-fold in prospective follow-ups. HBsAg seroclearance, cirrhosis, and hepatocellular carcinoma were detected in 43 (10.8%), 4 (1%), and 1 (0.25%) patients, respectively.Conclusions:Fluctuations in serum ALT levels may change the prognosis of a HBV inactive carrier state.

Impact of Water Exchange Colonoscopy on Serum Sodium and Potassium Levels: An Observational Study

Concerns over the hypothetical adverse effects of water absorption and the disturbance of serum sodium and potassium levels prompted a quality assurance evaluation of water exchange (WE) colonoscopy. The purpose of this study was to evaluate the balance of water infused and suctioned in WE colonoscopy, and to quantify the acute impact on serum levels of sodium and potassium. Prospectively collected quality monitoring data of patients undergoing screening and surveillance colonoscopy at the Sacramento Veterans Affairs Medical Center were analyzed. Measurements were made of volume infused and suctioned during, and blood samples drawn 10 min before the start of and 10 min after completion of WE colonoscopy. Outcome measures included volume of water infused and suctioned, and serum levels of sodium and potassium. A total of 140 patients (134M:6F), mean age of 59, underwent WE colonoscopy. Mean total volume of water infused was 1,839 mL. A negative balance of an average of 22 mL was documented. The mean (standard deviation) values (in meq/L) of serum levels of sodium 139.33 (2.27) and 139.28 (2.32), and potassium 3.86 (0.36) and 3.91 (0.39), before and after colonoscopy, respectively, showed no significant change. The WE method allowed most of the water infused during colonoscopy to be recovered by suction at the completion of colonoscopy. Serum sodium and potassium levels did not change significantly within 10 min after completion. The WE method appears to be safe with minimal water retention and is devoid of acute fluctuations in serum levels of sodium and potassium.

Carbohydrate Antigen 125

Tumor markers are used for the screening, diagnosis, and stratification of cancer disease, but recently the role of some tumor markers has also been explored in the context of patients with heart failure (HF). Of all tumor biomarkers, carbohydrate antigen-125 (CA-125) has emerged as a potential biomarker in HF by showing correlations with clinical, hemodynamic, and echocardiographic parameters indicative of the severity of the disease. Interestingly, fluctuations in serum levels of CA-125 after treatment were also found, suggesting potential utility in a serial and long-term therapeutic intervention assessment. It has also been reported that in patients with HF, there is a significant correlation between CA-125 and brain natriuretic peptide levels. The aim of this article is to review the data currently available on serum levels of tumor markers in patients with chronic HF, focusing attention on the potential clinical use of CA-125.

The effects of weekly augmentation therapy in patients with PiZZ &amp;alpha;1-antitrypsin deficiency

BackgroundThe major concept behind augmentation therapy with human α1-antitrypsin (AAT) is to raise the levels of AAT in patients with protease inhibitor phenotype ZZ (Glu342Lys)-inherited AAT deficiency and to protect lung tissues from proteolysis and progression of emphysema.ObjectiveTo evaluate the short-term effects of augmentation therapy (Prolastin®) on plasma levels of AAT, C-reactive protein, and chemokines/cytokines.Materials and methodsSerum and exhaled breath condensate were collected from individuals with protease inhibitor phenotype ZZ AAT deficiency-related emphysema (n = 12) on the first, third, and seventh day after the infusion of intravenous Prolastin. Concentrations of total and polymeric AAT, interleukin-8 (IL-8), monocyte chemotactic protein-1, IL-6, tumor necrosis factor-α, vascular endothelial growth factor, and C-reactive protein were determined. Blood neutrophils and primary epithelial cells were also exposed to Prolastin (1 mg/mL).ResultsThere were significant fluctuations in serum (but not in exhaled breath condensate) levels of AAT polymers, IL-8, monocyte chemotactic protein-1, IL-6, tumor necrosis factor-α, and vascular endothelial growth factor within a week of augmentation therapy. In general, augmented individuals had higher AAT and lower serum levels of IL-8 than nonaugmented subjects. Prolastin added for 3 hours to neutrophils from protease inhibitor phenotype ZZ individuals in vitro reduced IL-8 release but showed no effect on cytokine/chemokine release from human bronchial epithelial cells.ConclusionWithin a week, augmentation with Prolastin induced fluctuations in serum levels of AAT polymers and cytokine/chemokines but specifically lowered IL-8 levels. It remains to be determined whether these effects are related to the Prolastin preparation per se or to the therapeutic efficacy of augmentation with AAT.

Patients with IgA nephropathy exhibit high systemic PDGF-DD levels

Platelet-derived growth factor (PDGF) is a central mediator of mesangioproliferative glomerulonephritis (GN). In experimental mesangioproliferative GN, PDGF-DD serum levels, unlike PDGF-BB, increased up to 1000-fold. We assessed disease activity in 72 patients with GN, established a novel PDGF-D ELISA and then determined their PDGF-DD levels. In parallel, we studied renal PDGF-DD mRNA expression by RT-PCR. PDGF-DD serum levels in patients with IgA nephropathy (IgAN) were significantly higher (1.67 +/- 0.45 ng/ml) and in patients with lupus nephritis significantly lower (0.66 +/- 0.86 ng/ml) compared to healthy controls (1.17 +/- 0.46 ng/ml), while patients with focal segmental glomerulosclerosis, membranous GN and ANCA-positive vasculitis did not differ from controls. The subgroup of IgAN patients with elevated PDGF-DD levels (27% of samples) did not differ in their clinical features from those with normal PDGF-DD levels. In IgAN patients with repetitive PDGF-DD determinations, most exhibited only minor fluctuations of serum levels over time. Intrarenal PDGF-DD mRNA expression did not differ between controls and patients, suggesting an extrarenal source of the elevated PDGF-DD in IgAN. Serum PDGF-DD levels were specifically elevated in patients with IgAN, in particular in those with early disease, i.e. preserved renal function. Our data support the rationale for anti-PDGF-DD therapy in mesangioproliferative GN.

The Combined Contraceptive Vaginal Ring (NuvaRing): Evaluation of the Clinical and Pharmacological Evidence

The NuvaRing((R)) is a vaginal ring contraceptive that releases a daily dose of 15 microg ethinylestradiol and 120 microg etonogestrel through the vaginal epithelium, thereby avoiding the daily fluctuations in serum levels typically observed with combined oral contraceptives. Each ring is designed for a single 3-week use followed by a 1-week ring-free period. The ring offers robust inhibition of ovulation, yielding a Pearl Index of 0.65 for European women in registration trials. The ring has the same contraindications as combined oral contraceptives. The vaginal ring is a highly effective, safe and well-tolerated method of hormonal contraception designed for reproductive-aged women who desire freedom from the daily pill.

Fibronectin, complement and immunoglobulins in serum after surgery.

In recent years it has been suggested that fibronectin is a non-specific opsonic protein of significance in host resistance against septic complications following trauma and surgery. The aim of the present study was to investigate the fluctuations in serum levels of fibronectin, immunoglobulins IgG and IgM, and complement factors C3 and C4 postoperatively. Serum samples were obtained pre-operatively and at different intervals postoperatively in 72 patients admitted for elective surgical procedures on the alimentary tract, the heart and the hip joint. The mean pre-operative fibronectin values were 257 +/- 79 micrograms/ml. The lowest values (166 +/- 65 micrograms/ml) were found immediately after the operation, followed by an increase which did not reach pre-operative levels within 120 h. Five patients who developed postoperative complications and 14 patients with malignant disease did not differ significantly either in their pre- or postoperative fibronectin levels, compared with the whole group. The lowest fibronectin levels seen were also significantly above the concentrations necessary to promote binding of gelatinized test particles to macrophages and monocytes in vitro. There was a significant decrease in C3, C4 and IgG levels postoperatively whereas IgM levels were unaltered. The observed reduction did not extend below the lower normal levels for these proteins. The probable mechanism behind the reduction in serum levels seems to be a sequestration at the site of tissue injury. The postoperative reduction in circulating fibronectin levels has probably no implications for host resistance against septic complications. When sequestered into the site of injury, it may, however, be of significance for normal wound healing, due to its cell-matrix interactions.

The Use of Dehydroepiandrosterone Therapy in Clinical Practice

Dehydroepiandrosterone (DHEA) therapy is controversial due to sensationalized reports of epidemiologic studies and the over-the-counter availability of DHEA. Human clinical trials have investigated the potential efficacy of DHEA therapy in multiple conditions with resultant inconsistencies in findings. DHEA is unique compared with other adrenal steroids because of the fluctuation in serum levels found from birth into advancing age. The lower endogenous levels of DHEA and DHEA sulfate found in advancing age have been correlated with a myriad of health conditions. Also, some studies suggest gender-specific actions of endogenous and exogenous DHEA. We reviewed only pharmacokinetic studies and human clinical trials investigating the efficacy of DHEA therapy that were placebo-controlled as these provided the most reliable scientific basis for the evaluation of DHEA therapy. Pharmacodynamic studies suggest that doses of 30-50mg of oral DHEA may produce physiologic androgen levels, especially in women. These studies report a dose-dependent effect and lack of accumulation of serum androgen levels. Pharmacologic studies also reveal a gender-specific response to DHEA therapy such that testosterone levels are increased in women but not in men. Clinical trials suggest that 50mg of oral DHEA, but not <30mg, can increase serum androgen levels to within the physiologic range for young adults with primary and secondary adrenal insufficiency, possibly improve sexual function, improve mood and self-esteem, and decrease fatigue/exhaustion. Whereas DHEA replacement therapy may be effective in treating patients with adrenal insufficiency, human clinical trials investigating its efficacy in conditions such as systemic lupus erythematosus, HIV, Alzheimer disease, advancing age, male sexual dysfunction, perimenopausal symptoms, depression, and cardiovascular disease have not provided consistent findings.

Long-Cycle Treatment with Oral Contraceptives

The conventional regimen of oral contraceptive (OC) use mimics the natural cycles by causing regular withdrawal bleeding, which can be avoided by omission of the hormone-free interval of 7 days. Consequently, long-cycle regimens with continuous administration of OCs for 3 or 6 months followed by a hormone-free interval of 7 days may reduce the frequency of menstruations and cycle-dependent complaints. Surveys have revealed that, despite a higher rate of irregular bleeding, the majority of women prefer the long-cycle regimen to the conventional OC regimen with regular bleeds every 4 weeks because it may improve quality of life. As this regimen increases the contraceptive efficacy to a large degree, continuous treatment with OCs may prevent unintended pregnancies in women who miss a pill or are concomitantly treated with drugs that are able to impair the efficacy of OCs. Postponement of withdrawal bleeding may also reduce or prevent menses-associated disorders such as hypermenorrhoea and dysmenorrhoea, and have beneficial effects in patients with haemorrhagic diathesis, endometriosis, uterine leiomyoma and polycystic ovary syndrome. Continuous use of OCs prevents the cyclic fluctuations of serum levels of ethinylestradiol and progestogen and, hence, the cyclic variations of metabolic serum parameters. Although the long-cycle regimen is initially associated with an elevated rate of irregular bleeding, the total number of bleeding days that require sanitary product protection is lower than during conventional OC treatment. Many physicians tend to prescribe extended OC cycles for postponement of menstruation or reduction of frequency of regular bleeding. This review summarises and examines the available data on OC long-cycle regimens. The data suggest that the rate of treatment-related side effects with OCs according to the long-cycle regimen is similar to that of conventional OC regimens. However, clinical trials are necessary to assess the impact of long-term OC long cycles on safety, particularly the risk of cancer and cardiovascular disease, and fertility after discontinuation of treatment.

Daily rhythm in serum melatonin and leptin levels in the Syrian hamster (Mesocricetus auratus)

Melatonin is produced and secreted by the pineal gland in a rhythmic manner; circulating levels are high at night and low in the day. Leptin is a hormone secreted by adipocytes as a product of the obese gene and plays an important role in regulating body energy homeostasis and reproductive function in rodents and humans. The present study was conducted to examine daily fluctuations in serum levels of melatonin and leptin in Syrian hamster. We measured serum leptin and melatonin levels by ELISA in (a) intact and pinealectomized (pinx) male hamsters kept under long daylight conditions [14 h of light (14L)]; (b) intact and pinx hamsters under short daylight (10L); and (c) intact hamsters in constant light (24L). Blood samples were obtained every 2 h throughout a 24-h period. Statistically significant circadian variations were found in both melatonin and leptin profiles. Their relationship was inverse, i.e. when melatonin was high in the serum, leptin was comparably low. These results suggest that there is a rhythm in leptin levels in the adult male Syrian hamster and this rhythm is pineal gland (melatonin) and/or photoperiod dependent.

Determination of trace elements (Cu, Zn, Mn, Pb) and magnesium by atomical absorption in patients receiving total parenteral nutrition

OBJECTIVE: We measured the serum levels of four trace elements (Cu, Zn, Mn, Pb) and Mg in surgical patients receiving total parenteral nutrition (TPN). The clinical implications and the results are discussed. METHODS: Two groups of patients were studied: the first group ( n = 40) was our study group and the second ( n = 40) was the control group. Four measurements of each trace element (TE) in blood serum were carried out: one before initiating TPN, one 24 h after, one 3 d later, and the last one immediately after discontinuing TPN. Each measurement was repeated twice. The Perkin-Elmer atomic absorption spectrophotometer (model 2380) with furnace graphite HGA-300 was used to measure the TE levels and an acetylene flame was used to measure the Mg levels. RESULTS: Levels of all the TEs, except Pb, were lower before the administration of TPN compared with the control group ( P < 0.05). The levels of TEs during and immediately after TPN were generally lower in comparison with the initial measurement before the administration of TPN. CONCLUSION: The results of this study suggest that it may be necessary to 1) add Cu, Zn, Mn, and Mg to the parenteral nutritional solution and 2) follow the fluctuations in serum levels during the administration of TPN.