Glycemic Serum Research Articles

Cardiovascular diseases risk assessment: the Italian Health Examination Survey 2023 - CUORE Project

Abstract Background The reduction of NCDs premature mortality is pursued by the WHO; risk conditions targets are recommended as well as population-level monitoring of cardiovascular disease (CVD) risk. The Italian Ministry of Health (MoH) has strengthened prevention/health promotion and supported periodic CVD risk assessment through national health examination surveys (HESs), funded by the MoH-CCM and conducted within the CUORE Project. Methods In 2023 a new HES started including the 10-year fatal and non-fatal CVD risk assessment based on knowledge of sex, age, smoking habit, measured systolic blood pressure and fasting total and HDL serum cholesterol, and presence of diabetes (on measured fasting serum glycemia and/or treatment) and anti-hypertensive therapy. Up to now, data from random samples of residents in 7 Regions (of 20 regions) distributed in North, Centre and South of Italy, aged 35-69 years, without previous CVD, are available (585 men, 617 women). Determinations were assayed by a central lab. CUORE Project functions developed on and for the Italian adults were used. Results Mean values of the CVD risk assessment resulted 6.9% (95% CI: 6.3-7.4) in men and 2.3% (2.1-2.5) in women. For men aged 35-44 years risk was 1.6% (1.5-1.8), for 45-54 years 3.8% (3.5-4.2), for 55-64 years 10.0% (9.0-10.9), for 65-69 years 17.6% (16.4-18.9); for women was 0.5% (0.4-0.6), 1.0% (0.9-1.1), 3.3% (2.9-3.7) and 6.0% (5.5-6.6) respectively. Prevalence of CVD risk less than 5% was 57% (49-64) in men and 88% (84-93) in women, of 10-15% risk were 22% (15-28) of men and 9% (5-14) of women, of 15-20% risk were 5% (1.6-8.0) of men and 0% of women, of over 20% risk were 2% (0-3.6) of men and 0% of women. Conclusions Compared to 2008, these data showed stable mean levels of CVD risk both in men and women at any age-classes and stable prevalence of CVD risk classes. CVD risk perception represents a challenge in primary prevention especially for young age groups and women. Key messages • In the Italian general population, CVD risk assessment remained stable compared to 15 years ago. • CVD risk perception represents a challenge in primary prevention.

Lipids and glycemia profiles in adults: the Italian Health Examination Survey 2023 - CUORE Project

Abstract Background WHO recommends monitoring glycemic and lipid profiles in the population to control and prevent NCDs. The target for glycemic/diabetes is to halt the rise within 2025 (2010 as baseline). The Italian Ministry of Health (MoH) has strengthened prevention/health promotion and supported their periodic assessment through national health examination surveys (HESs), financed by MoH-CCM and conducted within the CUORE Project. Methods In 2023 a new HES started including the assessment of fasting serum glycemia, total and HDL cholesterolemia and triglyceridemia. Up to now, data from random samples of residents in 7 Regions (of 20 regions) distributed in North, Centre and South of Italy and aged 35-74 years are available (687 men, 704 women). Glycemia and lipids profiles were assayed by a central lab. Elevated glycemia/diabetes (DM): glycemia ≥ 126 mg/dl and/or on medication. Elevated total cholesterol/hypercholesterolemia (HChol): total cholesterol ≥ 240 mg/dl and/or on medication. Results Glycemia mean level was 97 mg/dl (95%CI: 95-99) in men and 90 mg/dl (89-91) in women; DM resulted 10% (5-14) and 8% (4-12) respectively. Among those with DM, about 2 in 10 men and 1 in 10 women were unaware; about 2 and 3 of 10 were aware but not on medication, respectively. Total cholesterol mean level was 192 mg/dl (189-195) in men and 200 (197-202) in women; HChol resulted 24% (18-31) and 29% (22-36) respectively. Mean level of HDL cholesterol was 48 mg/dl (48-49) in men and 59 mg/dl (58-60) in women; mean level of triglycerides was 121 mg/dl (115-126) and 95 mg/dl (92-98) respectively. Among those with HChol, about 1 in 10 men and 2 in 10 women were unaware; about 2 of 10 were aware but not on medication. Conclusions Compared to 2008, these preliminary data showed a significant decrease of glycemia, total cholesterol and triglycerides means values both in men and women, as well as of DM and HChol prevalence, but improvements on their awareness and control are still necessary. Key messages • In the Italian adult general population significant improvements in lipids and glycemia profiles occurred compared to 15 years ago. • The implementation of periodic health examination surveys is important for estimating indicators based on objective measurements and for estimating awareness and control of risk conditions.

Intravenous infusion of lidocaine as a component of opioid-free anesthesia in thoracic surgery: prospective randomized single-center observational study

BACKGROUND: The possibility of reducing doses of narcotic analgesics during the perioperative period is widely discussed in modern scientific literature. This direction is called opioid-free anesthesia and is used in abdominal surgery, oncology, gynecology, and other areas. Publications on the use of opioid-free anesthesia in thoracic surgery are scarce.
 OBJECTIVE: To evaluate the analgesic effectiveness of intravenous lidocaine infusion as a component of anesthesia in thoracic surgery.
 MATERIALS AND METHODS: Ninety patients who underwent open lobectomy or pneumonectomy were examined. Depending on the analgesic component, patients were divided into three groups: group 1 (n=30) received intravenous infusion of lidocaine, group 2 (n=30) received epidural block, and group 3 (n=30) had fentanyl infusion. Blood pressure, heart rate, cortisol, and blood serum glycemia levels were measured. The intensity of postoperative pain syndrome and the need for promedol, tramadol, and sanitation fibrobronchoscopy were assessed. Arterial hypotension and frequency of postoperative nausea and vomiting were recorded. The length of stay of the patients in the intensive care unit and hospital was recorded.
 RESULTS: Cortisol levels did not differ between groups (p=0.26). The glucose level in the epidural block group was significantly lower than that in other groups (p=0.011). A significant increase in mean blood pressure and heart rate was observed in the opioid analgesia group (p 0.001). The lowest severity of pain 6 h after surgery was observed in the epidural blockade and lidocaine groups (p 0.001). Perioperative hypotension was more common in the epidural analgesia group (p=0.045). The incidence of postoperative nausea and vomiting was higher in the opioid anesthesia group (p=0.004). In the fentanyl infusion group, sanitary fibrobronchoscopy was more often required to eliminate atelectasis (p=0.039). The number of bed days spent in the ICU was significantly higher in the opioid analgesic group (p=0.002); however, no significant differences were noted between the groups regarding the number of days spent in the hospital (p=0.228).
 CONCLUSION: Opioid-free anesthesia based on intravenous lidocaine infusion, as a component of anesthetic management in thoracic surgery, provides sufficient perioperative stability of hemodynamic and neuroendocrine status, has a pronounced analgesic effect, with less opioid consumption on the first day after surgery, and helps reduce the length of stay in the intensive care unit and hospital.

Cardiometabolic sex differences in adults born small for gestational age.

This study aimed to assess the cardiometabolic sex similarities and differences in adults born small for gestational age. This study was an ambispective cohort study from a birth registry in Barcelona, Spain, including 523 adult participants (20-40 years-old) subdivided as born small for gestational age (SGA, if birth weight <10th centile) or adequate fetal growth for gestational age (AGA). Cardiometabolic health was assessed by echocardiography, electrocardiogram, blood pressure measurement, vascular ultrasound, anthropometric measurements, and serum glycemia and lipid profile. Stratified analyses by sex were performed by estimation of adjusted absolute difference (AAD) using inverse probability weighting. Compared with AGA, the stratified analyses by sex showed a more pronounced reduction in ejection fraction [AAD: female -1.73 (95% CI -3.2 to -0.28) vs. male -1.33 (-3.19 to 0.52)] and increment in heart rate [female 3.04 (0.29-5.8) vs. male 2.25 (-0.82 to 5.31)] in SGA females compared with SGA males. In contrast, a more pronounced reduction in PR interval [female -1.36 (-6.15 to 3.42) vs. male -6.61 (-11.67 to -1.54)] and an increase in systolic blood pressure [female 0.06 (-2.7 to 2.81) vs. male 2.71 (-0.48 to 5.9)] and central-to-peripheral fat ratio [female 0.05 (-0.03 to 0.12) vs. male 0.40 (0.17-0.62)] were mainly observed in SGA male compared with SGA female. Sex differences were observed in the effect of SGA on cardiometabolic endpoints with female being more prone to cardiac dysfunction and male to electrocardiographic, vascular, and metabolic changes. Future research including sex-stratification data is warranted.

O-8 THE IMPORTANCE OF LYSOSOMAL ACID LIPASE DEFICIENCY IN THE ETIOLOGICAL INVESTIGATION OF CRYPTOGENIC LIVER DISEASE IN ADULTS: A MULTICENTER STUDY

Lysosomal acid lipase deficiency (LAL-D) is a rare genetic disease associated with lipid metabolism deregulation leading to atherosclerosis, dyslipidemia, and hepatic steatosis, with potential progression to cirrhosis. Investigation of LAL-D in patients with chronic liver disease is not routinely performed in most centers. The aim of this study was to evaluate whether it is worthwhile to investigate LAL-D in patients with liver disease of unknown etiology, and if there is any particular population that this search should be focused. This was a multicenter cross-sectional study in 295 patients followed with presumed cryptogenic liver disease from four tertiary centers in Brazil. Clinical, demographic and laboratory data from participants were assessed, with the exclusion of all known causes of liver disease. All patients were submitted to the investigation of LAL enzyme activity. The exams were collected on dried blood spot (DBS). A total of 135 patients were included in the study. Three patients (2.22%) presented values of LAL below the reference limit, compatible with LAL-D. The mean age of these patients was 43.9±10.1 years, of which 2 were females. The mean BMI was 24.3±0.7 and mean serum glycemia was 89.7±3.2 mg/dL. The mean serum HDL and triglycerides were 21.7±3.2 mg/dL and 206.7±25.5 mg/dL, respectively. Despite being a rare disease, also in our study population, LAL-D investigation may be considered in those individuals without overweight with reduced serum HDL and elevated triglycerides levels and chronic liver disease of unknown etiology.

MO462TIME-TRAJECTORIES OF RENAL FUNCTION AND OUTCOMES IN ELDERLY INDIVIDUALS WITH CKD OF VARIOUS ETIOLOGY

Abstract Background and Aims Despite hypertension ranks among the leading causes of chronic kidney disease (CKD), the impact of chronic hypertensive nephropathy, the so-called “nephrosclerosis” (NS), on CKD progression towards end-stage kidney disease (ESKD) is often unpredictable, particularly in older populations. We run a prospective, observational study to define renal function patterns and outcomes in elderly individuals with or without NS-related CKD. Method 304 elderly patients with already established CKD (mean age 69±4 y; mean eGFR 44.2±19.6 mL/min/1.73 m2; male= 64.1%), followed in our outpatients’ clinic were categorized according to the etiology of CKD. NS was defined as the presence of CKD associated with long-term essential hypertension, hypertensive retinopathy, left ventricular hypertrophy and minimal proteinuria. Time-trajectories in eGFR (CKD-Epi) were computed over a 4-year follow-up. In addition, we analysed the occurrence of a composite outcome of doubling of serum creatinine, eGFR reduction≥ 25% and/or ESKD needing dialysis or kidney transplantation. Results CKD was secondary to nephrosclerosis (CKD-NS) in 220 (72.3%) patients. Among the remaining 84 (27.7%), glomerular/diabetic diseases were the most frequent cause of CKD (47.6%). In the whole cohort, the average estimated annual GFR slope was of 1.8 mL/min/1.73 m2. eGFR decline was slower in CKD-NS as compared with the one of others (1.4 vs. 3.4 mL/min/1.73 m2; p&amp;lt;0.001. Figure 1). The composite renal outcome during follow-up (median 36 mo.; range 6-48) occurred less frequently among elderly with CKD-NS (16/204 vs 14/70; p=0.01 Crude HR 0.43, 95%CI 0.22-0.85) and was associated at logistic analyses with etiology of CKD, serum total cholesterol, serum LDL cholesterol levels and glycemia (p ranging from 0.01 to 0.04). Conclusion Despite being highly prevalent in the elderly, NS is associated with a more favorable renal disease course as compared with other conditions. Therapeutic efforts to delay CKD progression in older populations should go beyond just optimizing blood pressure control and focus more on concomitant diseases.

Clinical, biological and electroencephalographic monitoring of newborns with neurological risk in the Neonatal Intensive Care Unit.

Newborns admitted to the Neonatal Intensive Care Unit (NICU) require increased attention regarding neurological assessment and monitoring, due to immaturity or certain conditions that occur during the perinatal and neonatal period. Hypoxic-ischemic encephalopathy (HIE) following perinatal asphyxia is one of the most studied clinical conditions due to the risk of medium- and long-term neurobehavioral outcome. We studied 43 newborns with HIE, for all 3 degrees of impairment, performed amplitude-integrated electroencephalography (aEEG) in the first hours of life and collected common laboratory tests, following serum glycemia at admission and creatinine, creatine kinase (CK) and lactate dehydrogenase (LDH) at admission and in the 3rd day of life. Newborns with mild HIE presented normal aEEG pattern and slightly elevated CK. A total of 80.9% of the newborns with moderate HIE had seizure patterns in aEEG, while among those with severe HIE, 71.4% had seizure patterns in aEEG and 28.5% burst suppression. CK and LDH were mean elevated in those with moderate HIE, and the newborns with severe HIE had also high creatinine values at admission and in the 3rd day of life. Statistically significant differences between the 3 degrees of HIE were noted in terms of creatinine (P=0.009) and CK (P=0.008) at admission and LDH in the 3rd day of life (P=0.036). Hypoglycemia was common in our study group. In conclusion, common blood tests in association with aEEG monitoring and rigorous neurological assessment can predict short-term outcome of HIE and multiorgan dysfunction and can help clinicians predict even long-term outcomes in severe HIE.

Predictors of Fatal Pulmonary Haemorrhage in Dogs Affected by Leptospirosis Approaching Haemodialysis.

A retrospective case control study, which aimed to evaluate potential clinical, laboratory and imaging predictors of fatal pulmonary haemorrhage in dogs with Leptospirosis submitted to haemodialysis. The study population was divided in two groups according to the presence (PH) or absence (nPH) of pulmonary haemorrhage. A statistical comparison was performed at hospital admission for clinical (spontaneous bleeding, icterus, and respiratory distress), laboratory (serum creatinine, urea, phosphate, calcium, bicarbonate, bilirubin, AST, ALT, ALKP, GGT, total protein, albumin, glycaemia, sodium, potassium, CRP, RBC, HCT, HGB, WBC, PLT, PT, aPTT, fibrinogen), and pulmonary radiographic findings between the two groups of dogs. At hospital admission, dogs developing pulmonary haemorrhage were more likely to have respiratory distress (p = 0.002), severely elevated serum bilirubin (p = 0.002), AST (p = 0.04), ALT (p = 0.012), ALKP (p = 0.002), reduced serum glycaemia (p = 0.014), and thrombocytopenia (p = 0.04). Respiratory distress and elevated serum bilirubin (≥11.5 mg/dL) were independently associated with increased risk of pulmonary haemorrhage. In conclusion, the presence of respiratory distress at hospital admission is strongly associated (OR 40.9) with increased risk of pulmonary haemorrhage, even though no abnormalities are found at chest radiography.

The ketogenic diet corrects metabolic hypogonadism and preserves pancreatic \xdf-cell function in overweight/obese men: a single-arm uncontrolled study

BackgroundOverweight and obesity are increasingly spread in our society. Low testosterone levels are often present in these patients, the so-called metabolic hypogonadism, that further alters the metabolic balance in a sort of vicious cycle. Very low-calorie ketogenic diet (VLCKD) has been reported to efficiently reduce body weight, glycaemia, and the serum levels of insulin, glycated hemoglobin, but its effects on β-cell function and total testosterone (TT) levels are less clear.AimTo evaluate the effects of VLCKD on markers suggested to be predictive of β-cell dysfunction development, such as proinsulin or proinsulin/insulin ratio, and on TT values in a cohort of overweight or obese nondiabetic male patients with metabolic hypogonadism.MethodsPatients with overweight or obesity and metabolic hypogonadism underwent to VLCKD for 12 weeks. Anthropometric parameters, blood testing for the measurement of glycaemia, insulin, C-peptide, proinsulin, TT, calculation of body-mass index (BMI), and HOMA index were performed before VLCKD and after 12 weeks.ResultsTwenty patients (mean age 49.3 ± 5.2 years) were enrolled. At enrollement all patients presented increased insulin, HOMA index, C-peptide, and proinsulin levels, whereas the proinsulin/insulin ratio was within the normal values. After VLCKD treatment, body weight and BMI significantly decreased, and 14.9 ± 3.9% loss of the initial body weight was achieved. Glycaemia, insulin, HOMA index, C-peptide, and proinsulin significantly decreased compared to pre-VLCKD levels. Serum glycaemia, insulin, C-peptide, and proinsulin levels returned within the normal range in all patients. No difference in the proinsulin/insulin ratio was observed after VLCKD treatment. A mean increase of 218.1 ± 53.9% in serum TT levels was achieved and none of the patients showed TT values falling in the hypogonadal range at the end of the VLCKD treatment.ConclusionsThis is the first study that evaluated the effects of VLCKD on proinsulin, proinsulin/insulin ratio, and TT levels. VLCKD could be safely used to improve β-cell secretory function and insulin-sensitivity, and to rescue overweight and obese patients from β-cell failure and metabolic hypogonadism.

Influência da vitamina C na lipoperoxidação hepática e muscular de camundongos C57BL/6 submetidos à dieta de cafeteria

Analisar o efeito do tratamento com vitamina C sobre a lipoperoxidação hepática e muscular, assim como sobre parâmetros bioquímicos de camundongos C57BL/6 submetidos à dieta de cafeteria durante nove semanas. Dezessete camundongos da linhagem C57BL/6, com dois meses de idade foram alocados em três grupos: 1) Controle, 2) Cafeteria e 3) Cafeteria + Vitamina C. O ensaio biológico foi conduzido por nove semanas, os animais foram mantidos em jejum de doze horas, e depois de sacrificados, o sangue e os tecidos foram coletados para dosagens bioquímicas. A partir de amostras de fígado e músculo sóleo, foram quantificados os teores de espécies reativas ao ácido tiobarbitúrico (TBARS) e de lipídeos totais. Os fígados dos camundongos alimentados com dieta de cafeteria tratados ou não com vitamina C apresentaram maiores teores de TBARS comparados aos controles (p&lt;0,05). Já o teor de TBARS muscular foi maior nos camundongos do grupo Cafeteria + Vitamina C comparado àquele encontrado para os animais Cafeteria e Controle (p&lt;0,05). As concentrações de colesterol hepático e muscular foram mais elevadas no grupo Cafeteria + Vitamina C comparadas às dos grupos Controle e Cafeteria (p&lt;0,05). O tratamento com vitamina C aumentou a lipoperoxidação muscular, mas não influenciou esse parâmetro no fígado de camundongos C57BL/6 alimentados com dieta de cafeteria. Além disso, a vitamina C elevou a concentração de colesterol nos tecidos hepático e muscular, mas não alterou a glicemia e os lipídeos séricos dos animais após nove semanas de tratamento.

Effect of pre-anesthetic fasting on gastric emptying and plasma glucose in healthy dogs of different age groups

ABSTRACT: Gastric emptying and plasma glucose were evaluated in young and adult dogs, fed with dry and wet food, submitted to different periods of pre-anesthetic fasting (6, 8, and 12 hours). Forty healthy dogs were selected, which were segmented into four groups according to the age group and type of diet. It was evaluated the gastric emptying by ultrasound and serum glycemia. Only 17.5% presented complete gastric emptying, and no significant differences were found between the 6 and 8-hour fasting evaluations, or between the age groups and the diets, considering significance level p&lt;0.05. Mean plasma glucose values from the groups indicated normal glycemia at all times of evaluation. A significant difference was found between the means of glycemia in young and adult dogs, with the 8-hour fasting with wet diet (p=0.03) and with 12 hours with dry diet (p=0.04). Healthy young and adult dogs, in physiological equilibrium, maintain average values of plasma glucose despite prolonged periods of pre-anesthetic fasting, which may be necessary, since 8-hour fasting for solid food is not enough to provide complete gastric emptying.

Low Levels of Glycemia within the First 48 Hours after Mechanical Thrombectomy for Acute Ischemic Stroke May be Associated with Better Clinical Outcome

Introduction: Many different factors may have an impact on clinical outcome after mechanical thrombectomy (MT) for acute ischemic stroke (AIS). We aimed to investigate levels of serum glycemia (GLY) within the first 48 hours after MT. Subjects and Methods: Consecutive AIS patients were enrolled in the retrospective bi-center study. Neurological deficit was assessed with National Institutes of Health Stroke Scale (NIHSS) and functional outcome after 3 months with modified Rankin scale with a score 0-2 for good outcome. Presence of symptomatic intracerebral hemorrhage was assessed according to the SITS- MOST criteria. Results: In total, 868 patients (442 males, mean age 69.7 ± 12.2 years) with a median of admission NIHSS 17 points were enrolled in the study and 253 (29.1%) of them were diabetics. Recanalization was reached in 758 (87.3%) patients. Patients with good outcome (412, 47.5%) had lower median of GLY (6.5 versus 7.4 mmol/L, P < .0001) within the first 48 hours after MT. Similar results were found also in diabetics (8.1 versus 9.6 mmol/L, P < .0001) and in patients with achieved recanalization (6.5 versus 7.5 mmol/L, P < .0001). Multivariate regression analysis with adjustment for potential confounders showed median of GLY (P = .0001, odds ratio: 0.830, 95% confidence interval: 0.755-0.913) as a predictor of good outcome after MT. Conclusion: Lower levels of GLY within the first 48 hours after MT may be associated with better functional outcome after 3 months.

Impacto de uma estratégia de manejo do excesso de peso infanto-juvenil

AIMS: To evaluate, through anthropometric and biochemical parameters, the impact of an overweight management strategy implemented in an outpatient clinic for childhood obesity in a public hospital.METHODS: Retrospective analysis of a cohort of 206 children and adolescents with a diagnosis of obesity or overweight, aged between 5 and 17 years, attended between 2010 and 2014 with an average period of three months during one year. The strategy evaluated consisted of counseling, with guidelines aimed at reducing sedentary activity time and increased physical activity and nutritional guidelines for healthier food choices. Were evaluated anthropometric parameters (body mass index, z-escore of body mass index by age, waist circumference, hip circumference and waist hip ratio) and biochemistry (fasting glucose, fasting insulinemia, homeostasis model assessment, total cholesterol (CT), high density lipoprotein (HDL-c), low density lipoprotein (LDL-c), triclycerides (TG) at the baseline, at 6 and 12 months of follow-up. Statistical analyzes were performed in the IBM SPSS Statistics 22.0, using the Generalized Estimating Equations model.RESULTS: In 12 months, there was a significant reduction in BMI, Z score of BMI/age, percentage of individuals with BMI/age z score ≥ +2, WHR, percentage of individuals with WC &gt; p90 and HC (p&lt;0,001). Serum glycemia and insulin levels did not show significant reduction, only a trend, as did TC, LDL-c and TG, but HDL-c levels had a significant increase (p=0.035).CONCLUSIONS: This strategy of management of childhood and adolescent overweight, based on counseling, made it possible to reduce significantly the levels of overweight, although the biochemical parameters were not reduced in the same proportion.

AVALIAÇÃO DOS EFEITOS DA Curcuma longa L. SOBRE A GLICEMIA DE RATOS WISTAR ALIMENTADOS COM DIETA DE CAFETERIA

A Curcuma longa L. é popularmente conhecida como cúrcuma e possui um composto bioativo chamado curcumina. No presente estudo, o objetivo foi avaliar o efeito da cúrcuma sobre a glicemia e crescimento de ratos Wistar. Foram utilizados 16 ratos machos, sendo divididos em 4 grupos de 4 animais, sendo grupo RC alimentados com ração comercial, grupo DC alimentados com dieta de cafeteria, grupo DC2C alimentados com dieta de cafeteria + 2% de cúrcuma adicionada na dieta e grupo DC5C com dieta de cafeteria + 5% de cúrcuma adicionada à dieta. Foi avaliado o consumo de ração diário (CRD), ganho de peso diário (GPD), conversão alimentar (CA), peso de órgãos (rim e baço) e a glicemia dos animais. Os resultados mostraram que houve diferença significativa (p&lt;0,05) no CRD, GPD, CA, peso de rim e baço, sendo que os animais alimentados com dieta de cafeteria os que apresentaram maior eficiência na dieta. A glicemia sérica não diferiu estatisticamente entre os tratamentos (p&gt;0,05). São necessários mais estudos para compreender o efeito da cúrcuma na dieta.

Effects of pasireotide treatment on coagulative profile: a prospective study in patients with Cushing's disease.

Cushing's disease (CD) is characterized by procoagulative profile. Treatment with cortisol-reducing medications might normalize the coagulation impairment potentially eliminating the risk of thromboembolic complications. The aim of this prospective study is to evaluate the effectiveness of 6-12 months of treatment with pasireotide (Signifor®, Novartis) 600 µg twice daily on coagulative factors in 21 patients (16 females, mean age 46 ± 12.2 years) with CD. Biochemical, hormonal (urinary free cortisol, UFC; late night salivary cortisol, LNSC; ACTH) and coagulative parameters as Protrombin time (PT), aPTT, factors VIII, IX and XI, antithrombin III, protein C, protein S, fibrinogen, were evaluated at baseline and during therapy. UFC showed a significant reduction from baseline (3.2 ± 1.8 vs. 1.0 ± 0.8, p < 0.0001) with normalization in 13/21 (61.9%) and in 7/16 (43.8%) at 6 and 12 months, respectively. On the same way LNSC returned to normal in 5/11 at 6 months, showing a trend to reduction (8.6 ± 5 vs. 4.1 ± 2.9), even though without statistical significance (p = 0.07). Throughout the treatment period there was an increase in serum glycaemia (5.5 ± 2.3 vs. 6.8 ± 2.3 mmol/L, p = 0.09), with a concomitant significant increase in HbA1c after 6 months (40.7 ± 8.4 vs. 50.7 ± 12.3 mmol/mol, p = 0.006). Regarding coagulative parameters, no differences were found neither in clotting nor in anticoagulant factors during therapy. No patients developed thrombotic complication during treatment. Pasireotide resulted an effective treatment in controlling hypercortisolism in more than half of CD patients with partial restoration also of circadian cortisol secretion. No significant improvements were observed on clotting factors; this fact might depend on persistence of typical alteration of CD, such as obesity and hypertension, and reflects also on the worsening in glucide metabolism induced by the drug. Clinical implications of persistent procoagulative impairment while on medical therapy should be considered.

Effects of endurance training and intense resistance training on arterial stiffness assessed by pulse wave velocity in elite athletes

There have been contradictory reports regarding resistance exercise and arterial stiffness. We examined the effects of long-term endurance training and intense resistance training on central hemodynamics, compared with healthy sedentary control (SED). We hypothesized that young adults participating in endurance sports would have decreased arterial stiffness, whereas those in intense resistance sports would have increased arterial stiffness. One hundred and thirty participants, 20–30 years; 46 intense resistance trained athletes (IRT) (weight-lifters), 42 endurance trained athletes (ET) (long distance runners) and 42 sedentary individuals (SED) were investigated by tonometry-pulse wave analysis, aortic pulse wave velocity (aPWV) and ambulatory blood pressure measurement (ABPM). Data were expressed as mean (SD). Differences were tested by analysis of variance, covariance and multiple linear regressions after adjustment for confounding variables. There were no differences among groups regarding age, height, serum glycaemia, cholesterol and triglycerides levels and ABPM. Weight, BMI and waist size were higher in IRT group than ET. Resting heart rate and augmentation index were lower in trained participants than sedentary. Brachial and central blood pressures were lower in ET than IRT. aPWV was significantly lower in endurance trained (5.58 ± 1.00 m/s) and higher in IRT (7.06 ± 0.87 m/s) and SED (7.18 ± 1.06 m/s). After multiple regression analysis, diastolic blood pressure (DBP) remained the only hemodynamic parameter correlated to the aPWV whatever the group. We find that aPWV is influenced by exercise modalities. DBP is an important determinant of aPWV in young.

Relations Between Diabetes, Kidney Disease and Metabolic Syndrome: Dangerous Liaisons

Abstract Background and aims: Diabetes mellitus is the disease-challenge of our century, characterized by an increase in serum glycemia, which may lead to the occurrence of micro- and macro-vascular complications with serious consequences on both patient and public health. The Framingham risk score was obtained from a complex study and it estimates the individual risk of each patient to develop a cardiovascular event over the next 10 years depending on certain parameters (age, smoking, total cholesterol, HDL-cholesterol, systolic blood pressure). Our study main aim was to evaluate the cross-associations between the components of the metabolic syndrome, cardiovascular risk, diabetes-related biological parameters and chronic kidney disease in patients hospitalized due to poor metabolic control. Material and methods: In this cross-sectional study, we enrolled 218 patients with type 2 diabetes, admitted in the Diabetes Clinic of the “Pius Brinzeu” Emergency Hospital Timisoara according to a consecutive-case population-based principle. Results: We observed that the quality of the glycemic control is impaired in patients with higher age; the body mass index was positively correlated with HbA1c and hypertension accompanies diabetes in more than half of the cases. Moreover, we observed that high levels of LDL cholesterol are significantly correlated with high levels of HbA1c. Conclusions: There was poor metabolic control in patients with associated complications such as hyperlipidemia, cardiovascular disease or chronic kidney diseases. Also, in most of the cases hypertension was associated with type 2 diabetes mellitus.

Can Urbanization, Social and Spatial Disparities Help to Understand the Rise of Cardiometabolic Risk Factors in Bobo-Dioulasso? A Study in a Secondary City of Burkina Faso, West Africa.

Background: Unplanned urbanization plays a key role in chronic disease growth. This population-based cross-sectional study assessed the occurrence of cardiometabolic risk factors in Bobo-Dioulasso and their association with urbanization conditions. Methods: Through spatial sampling, four Bobo-Dioulasso sub-spaces were selected for a population survey to measure the adult health status. Yéguéré, Dogona, Tounouma and Secteur 25 had very different urbanization conditions (position within the city; time of creation and healthcare structure access). The sample size was estimated at 1000 households (250 for each sub-space) in which one adult (35 to 59-year-old) was randomly selected. Finally, 860 adults were surveyed. Anthropometric, socioeconomic and clinical data were collected. Arterial blood pressure was measured and blood samples were collected to assess glycemia. Results: Weight, body mass index and waist circumference (mean values) and serum glycemia (83.4 mg/dL ± 4.62 mmol/L) were significantly higher in Tounouma, Dogona, and Secteur 25 than in Yéguéré; the poorest and most rural-like sub-space (p = 0.001). Overall, 43.2%, 40.5%, 5.3% and 60.9% of participants had overweight, hypertension, hyperglycemia and one or more cardiometabolic risk markers, respectively. Conclusions: Bobo-Dioulasso is unprepared to face this public health issue and urgent responses are needed to reduce the health risks associated with unplanned urbanization.

Is there room for behavioral and modifiable health-related targets in the lower urinary tract symptoms' scenario.

To better understand potential modifiable risk factors guiding preventive interventions against lower urinary tract symptoms (LUTS). A prospective cross-sectional study, including healthy men aged 40-70 years under routine urological evaluation, measured the strength of association between the International Prostate Symptom Score (IPSS) and socio-demographic, lifestyle, and health-related factors using logistic and linear regression adjusted for confounding factors. Men with urethral or prostate surgery were excluded. Among 743 men, mean age 59.64 ± 9.66, 22.6% reported moderate, and 5.0% severe LUTS. The adjusted odds of severe LUTS increased with: increasing age (OR = 1.07, 95% CI = 1.05-1.09, p < .0001), increasing prostate volume (OR = 1.02, 95% CI = 1.01-1.04, p = .004), decreasing education (tertiary qualification, no versus yes, OR = 2.34; 95% CI = 1.16-4.70; p = .0133), delayed ejaculation (yes versus no, OR = 2.63, 95% CI = 1.43-4.83, p < .0001), and increasing blood pressure (systolic ≥130mmHg, OR = 2.03, 95% CI = 1.44-2.86, p < .0001 or diastolic ≥85mmHg, OR = 1.47, 95% CI = 1.03-2.10, p = .0345); severe LUTS decreased with: increasing the weekly sexual frequency (OR = 0.80, 95% CI = 0.69-0.91, p = .0012) and increasing HDL cholesterol (OR = 0.98, 95% CI = 0.97-0.99, p = .037). Odds were not significant for age of sexual initiation, precocious ejaculation, masturbatory pattern, physical activity, smoking, alcohol consumption, penile length (objective and subjective), abdominal circumference, obesity, comorbid conditions, metabolic syndrome, serum glycaemia, testosterone, SHBG, PSA, and estradiol. One in every four men under routine urological evaluation who considered themselves healthy present moderate and severe LUTS. Modifiable behavioral (education, sexual frequency, and ejaculation) and health-related (blood pressure and HDL cholesterol) targets were identified for future interventional studies and potential preventive actions and patient counseling.

The effect of Sambucus nigra L. extract and phytosinthesized gold nanoparticles on diabetic rats

Nanomaterials such as gold nanoparticles (NPs) conjugated with natural products have shown good results in lowering the glycated hemoglobin and have an anti-inflamatory effect. The aim of our study is to evaluate the antidiabetic effect of NPs functionalized with Sambucus nigra L. (SN) extract on experimental model of diabetes in rats. Diabetes was induced to 18 Wistar male rats (n=6) by a single intramuscular injection of streptozotocin (30mg/kg body weight − b.w.). SN extract (15mg/kg b.w.), NPs (0.3mg/kg b.w.) and vehicle (normal saline) were administered by gavage once a day, every morning, for 2 weeks. Other 18 animals were used as control groups and were treated with the same compounds, at the same time. Afterwards, blood, liver and muscle samples were taken to assess the oxidant/antioxidant status and the liver for the evaluation of metalloproteinases (MMP)-2 and 9 activities, COX-2 and NFKB expressions and for immunohistochemistry. Serum glycemia, cholesterol, alanine aminotransferase (ALAT), aspartate aminotransferase (ASAT) were also measured.The administration of NPs extract increased the muscle and systemic GSH/GSSG ratio in the diabetic group vs. diabetic (p<0.03) or non-diabetic groups treated with vehicle (p<0.05) and decreased MDA levels compared to non-diabetic group (p<0.05). COX-2 expression (p<0.0001) and proMMP-2 activity (p<0.05) decreased after pretreatment with NPs in parallel with the reduction of Kupffer cells percent (<0.001). No morphological abnormalities were detected in histopathology. NPs present a great potential for further usage as adjuvants in the diabetic therapy due to the increase of antioxidant defence and reduction of MMPs activity and inflammation in liver tissue.