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Results in Journal Open Journal of Endocrine and Metabolic Diseases: 245

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Mohamed Moustapha, Molka Chadhli-Chaieb, Touhami Mahjoub, Larbi Chaieb
Open Journal of Endocrine and Metabolic Diseases, Volume 07, pp 141-150;

Background: PAI-1 (plasminogen activator inhibitor-1) is a powerful regulator of fibrinolysis and plasma level is high in type 2 diabetes and cardio-vascular disease, which is determined by genetic polymorphisms in PAI-1 gene and environmental factors. The aim of the study was to examine the determinants of plasma PAI-1 Ag level among type 2 diabetes patients. Methods: 491 Tunisian type 2 diabetes patients had clinical evaluation (weight, high, BMI, Waist Circumference), laboratory investigations including FBG Hb1Ac, cholesterol, triglyceride; HDL-cholesterol was done; plasma PAI-1 antigen level was done with ELISA; −675 4G/5G and −844 G/A polymorphisms of PAI-1 gene was done by PCR-ASA and PCR-RFLP respectively. Results: The mean age for our patients was 58.3 ± 10.5 years; sex-ratio = 0.92; mean PAI-1 level was 34.6 ± 21.3 ng/ml. We didn’t find correlation between PAI-1 level and BMI, but we have found significant correlation between PAI-1 and waist circumference (p = 0.032), most enhanced in men (P = 0.002), T2D patients who have FBG > 11 mmol/l had PAI-1 Ag level higher than those who have FBG < 11 mmol/l (P = 0.034), but no difference found between T2D with high Hb1Ac > 8% and those with Hb1Ac < 8%, significant correlation was seen between PAI-1 level and LDL-cholesterol (P = 0.05), high correlation between PAI-1 Ag level and −675 4G/5G polymorphism genotype was seen, 4G/4G carriers had the highest PAI-1 level, 4G/5G had intermediary level and 5G/5G had the lowest level (P < 0.001). No correlation was seen between PAI-1 Ag level and −844G/A polymorphism genotypes. Using multiple variable linear regression analysis, the independent factor associated with plasma PAI-1 level was −675 4G/5G polymorphism (regression coefficient β = 4.6, P < 0.01). Conclusion: the present study identifies −675 4G/5G not −844 G/A polymorphism of PAI gene as the principal determinant of plasma PAI-1 level in Tunisian T2D patients, the android fat distribution, dyslipidemia and hyperglycemia play a modest role in this variation.
Jacko R. Abodo, Jean B. Gbakayoro, Kouakou Brou, Georges G. Tiahou, Adélaïde Hué, Assita Yao, Jocelyne Danho, Adrien Lokrou
Open Journal of Endocrine and Metabolic Diseases, Volume 07, pp 127-139;

Objective: After the Ramadan fasting period, there is an increasing prevalence of diabetes in Cote d’Ivoire, in diabetes care centers. The objective of this study was to assess the consumption of sugary foods during this period and to determine the risks of diabetes in Muslim populations. Methods: Information was collected on the type and amount of sugary foods consumed. Methods for the preparation of these foods have been determined. Intake frequencies and postprandial glycemic responses were studied. The usual statistical methods were used. Results: Between 70% and 85% of the “fasters” consume plenty of these sugary foods during this period, with an average added sugar level varying between 10% and 35% and a daily consumption of between 250 cl and 0.5 l. The added sugar leads to hyperglycemia in both healthy subjects and pre diabetics. Conclusion: Regular consumption of these sugary foods results in significant hyperglycaemia throughout the month of fasting with a significantly higher blood glucose level in pre diabetic subjects. This makes pre diabetics people more at risk of diabetes among Muslim populations during Ramadan fasting.
Gaurav Puppalwar, Sandesh Sawant, Bhimsen Silgiri, Kirti Shukla, Hanmant Barkate
Open Journal of Endocrine and Metabolic Diseases, Volume 07, pp 111-125;

Objective: The present study assessed safety and efficacy of Glaritus® among adults with Type 1 Diabetes Mellitus (T1DM). Methodology: This prospective, randomized, multicenter, comparative, non-inferiority, open-label, parallel group, phase IV study was conducted in 14 study centers in India. Subjects were randomly allocated to receive either Glaritus® or Lantus® for 12 weeks. Each week, the dose of insulin was titrated to maintain target fasting blood glucose (FBG) level range of 80 - 120 mg/dL. Results: A total of 171 subjects were randomized (Glaritus® arm-86; Lantus® arm-85) and 161 subjects completed the study. The mean change in the glycosylated haemoglobin (HbA1c) levels from visit 3 (baseline) to visit 6 (end of trial) in Glaritus® arm was -0.69 ± 1.81 and in Lantus® arm was -0.53 ± 1.94. The mean change in glucose levels between week 1 and end of week 11 in Glaritus® arm was -8.81 ± 34.57 and in Lantus® arm was -5.28 ± 30. At least one hypoglycemic episode was experienced by 27.2% subjects of Glaritus® arm and 28.6% subjects of Lantus® arm. A total of 24 adverse events (AEs) such as pain, pyrexia, few infection related including urinary tract infections, metabolic related such as decreased appetite, musculoskeletal, neurological and skin related were reported in the study (Lantus® arm: 14 AEs; Glaritus® arm: 10 AEs). Conclusion: In this short term, 12-week study, biosimilar insulin glargine, Glaritus®, is comparable to the reference product, Lantus®, when combined with Insulin Lispro® in terms of glycemic control, risk of hypoglycemia and occurrence of adverse drug reactions among adults with T1DM.
Open Journal of Endocrine and Metabolic Diseases, Volume 06, pp 229-241;

Background: To understand what life is like for US children with a diagnosis of Growth Hormone Deficiency or Idiopathic Short Stature, the impact of short stature on Health related Quality of Life (HrQoL) was qualitatively examined and needs for care from the young patients and their parents perspective were identified. Methods: Focus group discussions with 26 American-English speaking and nine American-Spanish speaking children and their parents were conducted, transcribed verbatim and subsequently qualitatively analyzed by two independent raters, using an existing coding guideline, based on the multidimensional HrQoL concept and a special software (VERBI-Software MAXQDA 10). Results: A total of 1313 statements for the English-speaking and 447 statements for the Spanish-speaking families were categorized. In the US, the strongest frequency of mention was found for the HrQoL dimension “Social” across respondents, followed by “Treatment” and “Emotion”. Conclusion: Conducting and analyzing data generated from focus groups ensure that young patients’ experiences of disease are represented in the measure of outcomes for use in clinical trials and patient care.
Keshavan Prakash, Mary Kabadi, Udaya M. Kabadi
Open Journal of Endocrine and Metabolic Diseases, Volume 05, pp 117-123;

Objective: Idiopathic reactive hypoglycemia is defined as early postprandial hypoglycemia occurring on ingestion of high carbohydrate containing meal. Remission ensues with high protein low carbohydrate diet. This study assessed roles of insulin and glucagon in its onset and remission. Methods: Plasma glucose, insulin and glucagon were determined after an overnight fast and repeatedly until 180 minutes on ingestion of 3 meals; 100 g glucose; 100 g pure protein liquid and mixture of 50 g each at 14 days’ interval. Five adults with IRH and 6 age matched healthy volunteers participated. Results: In IRH, glucose ingestion induced prompt rise in glucose (5.1 ± 0.8 to10.5 ± 1.2 mM/L) followed later by hypoglycemia (2.6 ± 0.4 mM/L). Insulin rose from 7 ± 2 to 90 ± 18 mU/L. Glucagon rose initially (10% ± 2%) from elevated basal concentration (373 ± 57 mU/L) followed by later decline (-43% ± 12%). On protein ingestion, glucose declined followed by a restoration to basal level while both insulin and glucagon rose (28 ± 6 mU/L; 148% ± 38%, p < 0.01). However, insulin response was lower and glucagon rise was greater when compared to responses on glucose ingestion (p < 0.01). With mixed meal, glucose (8.2 ± 0.6 mM/L), insulin (65 ± 12 mU/L) and glucagon (48% ± 7%) responses were lesser than rises following glucose ingestion (p < 0.05) and hypoglycemia did not occur. Conclusion: In IRH, initial hyperglycemia on glucose ingestion may be exacerbated by paradoxical glucagon rise and hypoglycemia may be induced by increased insulin and declining glucagon responses. Resolution of hypoglycemia with high protein low carbohydrate diet may be attributed to blunting of insulin response and concurrent glucagon rise.
Miyako Mochizuki, Emi Hayashi, Atsushi Yoshimura, Yuko Toyoda, Lin Mei,
Open Journal of Endocrine and Metabolic Diseases, Volume 05, pp 131-137;

We studied the effects of exercise on muscle mitochondria, and lipid and glycogen content in non-alcoholic steatohepatitis (NASH) model rats. Male Sprague-Dawley rats were randomly separated into 3 groups: the control group was fed standard chow; the NASH group was fed a methionine-choline-deficient high-fat diet (MCD); the NASH-exercise group was fed the MCD and exercised three times a week. Exercise training consisted of continuous running for thirty minutes at a 13 m/min, 6° slope on a motor-driven rodent treadmill for 6 weeks. Mitochondria content in NASH group decreased in the both fiber types compared with those of the control group. As compared between the NASH and NASH-exercise groups, however, exercise not only promoted significant improvements in liver fibrosis and cirrhosis and triglyceride (TG) content but also increased mitochondria content in type I muscle fiber in particular. These data suggest that exercise improved hepatic steatosis in NASH model rats and can prevent the progression of NASH.
, Gonca Tamer, Nahide Ekici Gunay, Ilkay Kartal, Hamide Piskinpasa, Pinar Karakaya, Yildiz Okuturlar
Open Journal of Endocrine and Metabolic Diseases, Volume 07, pp 97-110;

Objective: To evaluate vitamin D status in relation to serum levels for parathyroid hormone (PTH) and corrected calcium among endocrine outpatients. Methods: A total of 760 patients (mean(SD) age: 40.0(12.6) years, 94.6% were females) admitted to our endocrinology outpatient clinic were included and evaluated with respect to patient demographics, serum levels for 25-hydroxyvitamin D (25(OH) D, ng/mL), PTH (pg/mL) and corrected calcium (mg/dL) as well as the vitamin D status. Results: Vitamin D deficiency was determined in 65.0% and elevated PTH levels in 20.3% of patients. iPTH levels were significantly higher in females than in males (58.9(40.4) vs. 45.1(26.2) pg/mL, p = 0.031) and in summer than in winter cases (63.9(47.7) vs. 54.2(32.8) pg/mL, p = 0.002), whereas no difference was found in serum levels for 25(OH) D, corrected calcium and phosphate with respect to gender and season. Significantly higher levels for iPTH were noted in vitamin D deficient patients (60.7(43.9) pg/mL) than in normal (51.1(33.4) pg/mL) and vitamin D insufficient (57.1(26.0) pg/mL) cases (p = 0.03). iPTH levels were correlated positively with age (r = 0.116, p = 0.001) and negatively with corrected calcium (r = −0.097, p = 0.008), P (r = −0.224, p = 0.000) and 25(OH) D (r = −0.134, p = 0.000), whereas no correlation was noted between 25(OH) D and corrected calcium levels. Conclusion: Our findings indicated that vitamin D deficiency in 65.0%, whereas PTH elevation only in 20.3% of endocrine outpatients, despite the significantly negative correlation of PTH to 25(OH) D and significantly higher levels of PTH among vitamin D deficient cases than in vitamin D insufficient and sufficient cases. Gender’s and seasonal differences had influence on serum levels for PTH but not on either 25(OH) D or corrected calcium, and no correlation was evident between 25(OH) D and corrected calcium levels.
Mussa H. Almalki, Badurudeen Mahmood Buhary, Imad Brema, Abdulrahman Almaghamsi, Saad Al Zahrani
Open Journal of Endocrine and Metabolic Diseases, Volume 07, pp 89-95;

Ectopic posterior pituitary is a disruption in the normal embryogenesis and is one of the rare but common causes of pituitary dwarfism. We report the MRI and clinical findings of a 13.5-year-old Saudi boy who was referred to the endocrine outpatient clinic with no significant complaints except for fatigue, exercise intolerance and short stature. Physical examination revealed short stature (below 2nd centile) with normal body proportion without any dysmorphic features and prepubertal secondary sexual characteristics and genitalia. Hormonal profile revealed: low thyroxine level, low gonadotrophins, low testosterone, low cortisol and blunted growth hormone (GH) response to insulin induced hypoglycaemia. Bone age was of 5 years old. The MRI result concluded with a diagnosis of ectopic posterior pituitary. A diagnosis of posterior pituitary ectopia (PPE) with panhypopituitarism was made.
K. Murali Manohar, M. Sasikala, P. Pavan Kumar, G. V. Rao, D. Nageshwar Reddy
Open Journal of Endocrine and Metabolic Diseases, Volume 06, pp 205-227;

Background/Aim: MicroRNAs with regulatory functions in gene expression are implicated in different diseases. The present study investigated differentially expressed miRNAs that possibly influence transcription factors involved in insulin gene expression in Chronic Pancreatitis (CP) employing bioinformatics approaches. Methods: Pancreatic tissues were collected from CP patients undergoing partial pancreatectomy (n = 16) and controls (n = 15) undergoing resections for non-pancreatic malignancies. MiRNA profiles obtained using microarrays were validated by qRT-PCR. Target search involving miRWalk and TarBase as well as functional annotation employing KEGG (Kyoto encyclopedia of genes and genomes) and DAVID (Database for Annotation) databases were performed. Ingenuity pathway analysis (IPA) was used to construct networks relating miRNAs to their target genes. mRNA and proteins related to insulin gene transcription factors and hormones were evaluated by qRT-PCR and western blotting followed by confirmation upon immunofluorescent staining. Results: Microarray data revealed 10 up-regulated and 15 down-regulated miRNAs in CP as compared to controls (Log2 FC > 2). Bioinformatic analysis showed 8399 target genes and KEGG pathway analysis suggested a role for the dysregulated miRNAs in modulating cytokine signaling, fibrosis, JAK-STAT signaling and insulin synthesis. IPA analysis suggested a simplified network attributing dysregulated miRNAs to NFκB-dependent cytokine signaling. Further, associations could be noted between miRNA 200b with Maf A, 138-1 with Neuro D and 27b with FoxO1. Decreases in mRNA levels of Pdx1, Neuro D and increases of Maf A and FoxO1 transcription factors could be noted (P < 0.01) in CP. These results were confirmed by western blotting and immunofluorescence staining. Conclusion: Our results identified dysregulation of miRNAs 138-1, 27b and 200b which were found to be associated with insulin gene transcription factors Neuro D, FoxO1 and Maf A respectively.
Mitsuo Nishimoto, Masafumi Toyoshima, , Hiroki Utsunomiya, Fumihiko Suzuki, , Hidekazu Nishigori, Takashi Suzuki, , , et al.
Open Journal of Endocrine and Metabolic Diseases, Volume 06, pp 193-204;

Objectives: Estrogens significantly contribute toward the growth and development of endometrial cancers. Two principal pathways have been implicated in the final steps of estrogen synthesis: the steroid sulfatase (STS) and aromatase pathways. In this study, we aimed to evaluate the possible effects of tumor-stromal interactions on local estrogen biosynthesis in endometrial cancer. We also assessed the biological effects of inhibitors of steroid sulfatase and aromatase in the co-culture system compared with usual monocultures. Methods/Materials: We isolated stromal cells from endometrial cancer patients to examine local biosynthesis of estrogens and tumor-stromal interactions. Next we examined the effects of steroid sulfatase inhibitor and aromatase inhibitor in monoculture of endometrial cancer cell line (Ishikawa) and in a co-culture system involving an Ishikawa cells and stromal cells. Results: Estrogen receptor and steroid sulfatase mRNA levels in cancer cells were significantly higher in the co-cultures compared with the monocultures of endometrial cancer cells. Estradiol and androstenediol concentrations were also significantly higher in the co-cultured cells. Proliferation of the cancer cells was significantly increased through the steroid sulfatase pathway, which metabolizes androgens, estrone sulfate, and estradiol sulfate as its substrates. However, its proliferation was significantly decreased by the treatment of steroid sulfatase or aromatase inhibitors. The significant growth inhibition by the steroid sulfatase and aromatase inhibitors were also observed in the co-culture system. Conclusions: We evaluated the effects of STS inhibitor and aromatase inhibitors on the proliferation of estrogen-dependent endometrial cancer cells. Considering that intratumoral estrogen metabolism plays an important role, our co-culture systems provide an environment similar to that of the tumor in living patients in terms of metabolism and synthesis of intratumoral estrogens. The results of this study may aid in achieving improved clinical responses from patients treated with STS inhibitors.
Tatiane Andreazza Lucchese, Amanda Maia Breis, Karine Rucker, Vagner Rosa Bizarro, Lis Marina Mesquita Araújo, Alessandre Gomes, Mikele Torino Paletti, Ana Luísa Conceição de Jesus, Marcella Garcez Duarte, Denise Rosso Tenório Wanderley Rocha, et al.
Open Journal of Endocrine and Metabolic Diseases, Volume 06, pp 28-37;

Diabetes and obesity are major health hazards in Latin America nowadays. Their prevalence has steadily increased since the eighties. Today, more than 50% of the population are overweight, 15% has obesity and 6% to 15% has diabetes. The nutrition transition is a long-term process that brings chronic metabolic diseases as an undesired consequence, whilst ultra processed foods become increasingly part of daily food choices. These changes bring impacts in all fields of daily life, especially in the economic and legal fields—the “Right to Health”—and regarding autonomy of the individual and their choices, when confronted with an ideal of health and well-being. Governments and citizens struggle to propose new pathways and find effective solutions to control both epidemics and solve these issues. This article poses the evolution of diabetes and obesity in the Mercosur, seeking a better understanding of these chronic, non-communicable diseases, and looking for concrete, effective solutions towards health in South America.
Fábio Ferreira Do Espírito Santo, Denise Rosso Tenório Wanderley Rocha, Alberto Krayyem Arbex
Open Journal of Endocrine and Metabolic Diseases, Volume 06, pp 20-27;

Down syndrome (DS) is the most common chromosomal abnormality in humans, and the most frequent cause of mental retardation. Patients affected by this syndrome show an increased prevalence of autoimmune diseases. The most common of those is Hypothyroidism. We present a case report describing the association of Down syndrome with Hyperthyroidism. An 18-year-old patient presented with a history of recurrent throat infections and intermittent diarrhea, having developed a total alopecia areata within one month from the first visit to the physician. After consultations with general practitioners, he was directed to an Endocrinology Ambulatory and diagnosed with a clear case of Graves’ disease associated with Down syndrome. Treatment was started with methimazole 20 mg/day, and after two months, was adjusted to 40 mg/day. The patient reached adequate clinical and laboratory balance after five months of treatment. Thus, the association between Down syndrome and Graves’ Disease is relevant in medical practice, due to its specific characteristics on diagnosis, and the need of an adequate treatment regarding this disease association.
Ghada M. El-Sagheer, Elwy Soliman, Ahlam M. Abdulla, Mohamed Ali
Open Journal of Endocrine and Metabolic Diseases, Volume 06, pp 183-191;

Background: Recent evidence for the effects of vitamin D and recognition of the high prevalence of its deficiency has increased the interest in it. Vitamin D-sub nutrition may contribute to the risk of a wide range of disorders. Methods: The females in the child-bearing period attending the endocrinology and orthopedic out-patient clinics complaining of pain and/or tenderness at the groin were evaluated. Patients with chronic metabolic or skeletal illness, primary hyperparathyroidism, and patients receiving drugs that interfere with bone mineral metabolisms were excluded. One hundred accepted and consented to participation in the study. All the participants were subjected to full history taking, clinical evaluation, laboratory investigations including serum Ca, Ph, PTH, ALP, TSH, F T4, F T3, Cortisol level, and 25(OH)D level. Plain X-ray was done for the regions of bony tenderness. The subjects were divided into 2 groups based on the presence or absence of pseudo-fractures (looser zones). They were treated and followed up till normalization of the laboratory parameters and healing of the looser zones. Results: The mean age for patients was 30.45 ± 5.8, their mean 25(OH) vitamin D level was 14.7 ± 5.9 ng/ml, the mean PTH was 195.7 ± 162.6, and looser zones were evident in the X-rays of 34 patients. The serum 25(OH)D showed significant negative correlations with veiling, parity, localized hip pain, and tenderness, ALP, PTH, but, a significant positive correlation with sun exposure, dairy products consumption, vitamin D supplementation, and serum calcium levels. The independent factors associated with hypovitaminosis D were the lack of sun exposure, lack of vitamin D supplementation, and the presence of pseudo- fracture (p ≤ 0.009, 0.038, and 0.001 respectively). No surgery was required in any of our patients. Conclusions: Vitamin D deficiency is common in our region. The main risk factors are decreased sun exposure, low dairy products consumption, and lack of vitamin D supplementation. Successful medical treatment may be helpful to satisfy the patient, avoid true fracture and further major surgical treatments.
Open Journal of Endocrine and Metabolic Diseases, Volume 06, pp 173-182;

This review article is aimed at describing the primary healthcare system of Pakistan and its challenges in the face of epidemic of type 2 diabetes, focusing particularly on the middle-aged population of rural area of Pakistan. The main concern in Pakistan is that its middle-aged population is facing the onslaught of obesity and overweight due to lack of physical activity. In addition unhealthy eating habits making it more difficult for this population to control their weight. All these factors are contributing to a high risk of type 2 diabetes for the population of Pakistan. This article provides insight into the primary health care system of Pakistan and highlights its deficiencies by identifying that its primary healthcare system has a poor utilization of health care services, the poor accessibility to health system and poor management of diabetes by the healthcare system, gender disparity and inequity in the health care system. The primary objective of this study is to provide an overview of self-management of diabetes among the middle-aged population of Pakistan and to identify the overall deficiencies in the primary healthcare system, its delivery and access to the system, barriers to self-management of diabetes and quality of life in that region.
Anna Malkina, Ronit Katz, Michael G. Shlipak, Joachim H. Ix, Ian H. de Boer, Mark J. Sarnak, Matthew Allison, Holly J. Kramer, Julie Lin, David Siscovick, et al.
Open Journal of Endocrine and Metabolic Diseases, Volume 03, pp 103-112;

Background: Obesity is associated with higher end-stage renal disease incidence, but associations with earlier forms of kidney disease remain incompletely characterized. Methods: We studied the association of body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR) with rapid kidney function decline and incident chronic kidney disease in 4573 non-diabetic adults with eGFR ≥ 60 ml/min/1.73m2 at baseline from longitudinal Multi-Ethnic Study of Atherosclerosis cohort. Kidney function was estimated by creatinine and cystatin C. Multivariate analysis was adjusted for age, race, baseline eGFR, and hypertension. Results: Mean age was 60 years old, BMI 28 kg/m2, baseline eGFRCr 82 and eGFRCys 95 ml/min/1.73m2. Over 5 years of follow up, 25% experienced rapid decline in renal function by eGFRCr and 22% by eGFRCys. Incident chronic kidney disease (CKD) developed in 3.3% by eGFRCys, 11% by eGFRCr, and 2.4% by both makers. Compared to persons with BMI 25, overweight (BMI 25 - 30) persons had the lowest risk of rapid decline by eGFRCr (0.84, 0.71 - 0.99). In contrast, higher BMI categories were associated with stepwise higher odds of rapid decline by eGFRCys, but remained significant only when BMI ≥ 35 kg/m2 (1.87, 1.41 - 2.48). Associations of BMI with incident CKD were insignificant after adjustment. Large WC and WHR were associated with increased risk of rapid decline only by eGFRCys, and of incident CKD only when defined by both filtration markers. Conclusions: Obesity may be a risk factor for kidney function decline, but associations vary by filtration marker used.
, Daisuke Ninomiya, Yoshihisa Kasai, , , Teru Kumagi, Masanori Abe
Open Journal of Endocrine and Metabolic Diseases, Volume 06, pp 159-166;

Liver marker {e.g., alanine aminotransferase (ALT) and aspartate aminotransferase (AST)} levels independently predict insulin resistance. The aim of the present study is to examine how changes in liver markers are associated with changes in insulin resistance after exercise in Japanese community-dwelling adults. The participants were 76 women aged 67 ± 6 years from a rural village. Nordic walk (NW) exercise of 120 min per week was performed for 12 weeks. Before and at the end of the 12-week intervention, various confounding factors and insulin resistance {e.g., Homeostatic Model Assessment of Insulin Resistance (HOMA-IR)} were measured. The baseline, follow-up, and changes in ALT/AST ratio (β = 0.390, P < 0.001; β = 0.393, P < 0.001; and β = 0.321, P = 0.004, respectively) were each significantly and independently associated with HOMA-IR. When the data were further stratified by baseline and change in ASL/AST ratio, changes in HOMA-IR decreased more significantly in participants with baseline ASL/AST ratio ≥ 0.762 and change in ALT/AST ratio of < 0 than those with change in ALT/AST ratio of ≥ 0 (baseline ASL/AST ratio < 0.762, P = 0.002 and ASL/AST ratio ≥ 0.762, P = 0.047). This study is of interest because liver transaminase markers, which are inexpensive and routinely collected in clinical settings, may provide a simple and accurate enhancement to models currently used to identify subjects with changes in insulin resistance. These results suggest that a higher baseline and decreased change in ALT/AST ratio may be a predictor for decreased insulin resistance after a 12-week walking exercise in community-dwelling middle-aged and elderly women.
, Julio César Jordan Balanza, Alicia Goya Pacheco, P.E.G. De Chaves Rodríguez, Manuel Barrera Gómez
Open Journal of Endocrine and Metabolic Diseases, Volume 06, pp 167-171;

The primary hyperparathyroidism during pregnancy is an infrequent disorder but it is rarer in a twin gestation. Often it is not suspected because the symptomatology is overlapped with the normal course of pregnancy and it is usually discovered after a routine blood test. Ultrasound is the best option to identify the adenoma, while the gold-standard is technetium-99 m sestamibi but is contraindicated in this situation. The treatment is controversial and depends of the time of the gestation: the medical therapy is accepted in the first and third trimester, and the surgery is reserved for the second trimester, where the side effects are low. We present a case of primary hyperparathyroidism in a twin pregnancy treated by a minimally invasive parathyroidectomy in the second trimester without consequences for both, mother and newborns.
Başar Öztürk, Ender Angın, Zehra Güçhan, Yasin Yurt, Mehtap Malkoç
Open Journal of Endocrine and Metabolic Diseases, Volume 06, pp 151-158;

Aims: Diabetes Mellitus (DM) is a metabolic disorder which affects whole systems of human body. This study aimed to compare the strength of foot muscles, dynamic balance, and peak plantar pressure between diabetic patients before developing polyneuropathy and healthy peers. Methods: 21 people, 11 diabetic patients and 10 age-matched healthy peers, were included in the study. A manual muscle tester (model 01163 Lafayette) was used to assess muscle strength. Pedobarography was the device to determine the distribution of plantar pressure into nine regions of foot. Dynamic balance was also measured by using a mobile platform (Techno-body, PK 200 WL, Italy). Results: Diabetic and control groups had similar muscle strength and dynamic balance (p > 0.05). Most of the plantar pressure findings were also similar (p > 0.05). There were significant differences in only two regions of foot between two groups (p < 0.05). Conclusion: Diabetes Mellitus is not a factor influencing balance and muscle strength before polyneuropathy. However, it is possible to state that it may negatively affect the distribution of plantar pressure so clinians should assess and treat this distribution in the patients with DM.
Braulio Roberto Gonçalves Marinho Couto, Katiussia Brito Porto, Fabiane De Freitas Sales, , Larissa Da Silva Pacheco, Lídia Christina Guimarães Pereira, Talita Santos de Almeida, Geiza Francielle Rodrigues de Souza, Mariana Santos Romualdo, Jaqueline Paulino de Souza, et al.
Open Journal of Endocrine and Metabolic Diseases, Volume 06, pp 141-149;

Introduction: Diabetes mellitus is a major public health problem that carries a high social and economic burden. Its diagnosis is unknown in half of individuals who have the disease. The diagnosis of the risk factors should be done in the beginning, since changes in lifestyle and hyperglycemic correction may delay the appearance of the disease and its complications. In this context, screening has been considered an important tool for an early detection of diabetes in asymptomatic adults. Objective: The objective is to track diabetes in people from BH, comparing genders. Patients and methods: People were interviewed with questions concerning the risk factors associated with the development of diabetes. According to the risk factors present, they were classified as non-diabetic [ND], pre-diabetic [PD] or diabetic [DM]. Statistical analyses were performed considering p ≤ 0.05 as significant. Results: 1264 individuals participated (5.5% DM, 6.5% PD, 88.0% ND). When grouped, PD and DM males were more prevalent than PD and DM females. Those in the DM group had higher blood pressure, age, glycaemia, number of past smokers, first-degree relatives with diabetes than either PD or ND. Both males and females in DM and PD groups had a higher waist circumference than did either ND males or females. ND men had a higher intake of fried food and smoked more in the past than ND women. Both ND and PD males had higher blood pressure than women from the same groups. Conclusion: Screening for diabetes is very important for an early diagnosis and to avoid future complications in patients. It’s possible to infer that women are more conscientious when it comes to taking care of themselves than men.
Ailan Pan, Longbo Liao, Qiaoyun Li, Liyan Qin
Open Journal of Endocrine and Metabolic Diseases, Volume 06, pp 135-140;

Objective: This study aims to explore the effect of peer support in improving self-efficacy of rural patients with type 2 diabetes and the application of drugs to reduce the pain from diabetes. Methods: Patients with type 2 diabetes in the rural area were selected and they were divided into the peer group and control group with voluntary. The patients in peer support group applied six kinds of activity patterns, while the control group was carried out with routine activities. Results: Comparison indexes for the two groups are mastering degree of related knowledge to diabetes, control compliance rate of indicators related to diabetes, and management of diabetes self-efficacy. Comparing with the control group, indexes in peer support group were significantly increased (P < 0.01). Meanwhile, in the table of diabetes distress, 17 items have been improved and the occurrence rate of painful diabetic decreased significantly (P < 0.01). Conclusion: Peer support can improve the rural patients’ self-efficacy of type 2 diabetes and decrease patients’ pain from type 2 diabetes mellitus.
Paulo Sérgio Chiamolera, Cristiano Alvariza Amaral, Monica Cristina De Oliveira Russo, Gilberto De Oliveira Netto, Ricardo Augusto Fernandes, Ricardo Teles de Andrade, José Luiz Gonçalves Buscariolli, Denise Rosso Tenório Wanderley Rocha,
Open Journal of Endocrine and Metabolic Diseases, Volume 06, pp 8-12;

Background: Diabetes mellitus is a worldwide epidemic. In 2002 there were 173 million diabetic adults worldwide, and these numbers are expected to reach up to 300 million people by 2030. Meanwhile, vitamin D deficiency has its worldwide prevalence directly influenced by factors as solar radiation, skin color, latitude and seasons, cultural habits of populations such as clothing and food, and these factors are important to explain the different prevalences of vitamin D deficiency in the world. Methods: A prospective cross-sectional cohort study was conducted with patients in the outpatient clinic of the Health Unit of the city of Mangueirinha, Paraná, Southern Brazil. Fifty-four type 2 diabetic patients were evaluated (38 women and 16 men), aged 55.8 ± 12.6 years. The following variables were evaluated: age, ethnicity, presence of type 2 diabetes (DM2), hypertension, dyslipidemia, weight, BMI, WC, blood pressure, blood glucose, glycated hemoglobin, ionized calcium, PTH, 25-OH Vit, total cholesterol, HDL, LDL, urea, creatinine, uric acid and red cell/hematocrit. Results: mean BMI was 30.2 ± 4.4 kg/m2, indicating class 1 obesity in this population. Fasting glucose levels were approximately 169.8 ± 74.5 mg/dL. The 25-OH vitamin D values for this population were 23.4 ± 8.3 ng/mL, and 13% of them showed 25-OH vitamin D levels above 30 mg/dL. Fifty percent of those patients had vitamin D levels lower than 30 mg/dL, and 37% had less than 20 mg/dL. Conclusions: this study suggests that vitamin D is associated with low levels of vitamin D in type 2 diabetic patients. Supplementation of vitamin D should be considered in diabetic patients, when levels under 30 mg/mL are found.
Mohamed Abdel-Fattah El-Feki, Nilly Helmy Abdalla, Mohamed Ibrahim Atta, Ahmed Amin Ibrahim
Open Journal of Endocrine and Metabolic Diseases, Volume 06, pp 126-134;

Objective: There are clinical and laboratory associations between thyroid and liver diseases. Hepatitis C virus (HCV) is known to be responsible for both hepatic and extrahepatic diseases. The most frequent and clinically important endocrine extrahepatic diseases are thyroid disorders and type 2 diabetes mellitus. We aim to study the relationship between the serum level of thyroid hormones (THs) and the severity of liver disease in patients with chronic hepatitis C virus (CHC) infection. Methods: 60 patients with CHC infection were selected for the study. They were divided into two groups: with or without liver cirrhosis. Those with liver cirrhosis were further subdivided according to the Child-Turcotte-Pugh scoring system. Serum levels of free T3 (FT3), free T4 (FT4) and TSH were measured to all patients. Results: There was decrease in the FT3 and FT4 levels and increase in the TSH levels in patients with CHC with cirrhosis when compared to patients with CHC without cirrhosis. Conclusion: Thyroid profile abnormalities were seen in cirrhotic HCV patients when compared to non-cirrhotic patients. The abnormalities in the serum level of THs (decreased FT3, FT4, and increased TSH) are strongly associated with the severity of liver damage and advancing of the child score.
Amani Alhozali, Aisha Al-Ghamdi, Jawaher Alahmadi
Open Journal of Endocrine and Metabolic Diseases, Volume 06, pp 121-125;

Background and objective: Thyroid cancer is the most common endocrine malignancy. This report aims to describe the pattern of thyroid cancer presentations at King Abdulaziz University Hospital, Jeddah. Methods: This was a retrospect chart review of all thyroid cancer cases diagnosed between 2001 and 2010 at King Abdulaziz University Hospital, Jeddah. We documented patients’ demographic and clinical data, including age at diagnosis, tumor type and size, extrathyroidal extension, and metastasis. Results: A total of 114 thyroid cancer cases were diagnosed from 2001 through 2010. Females comprise the majority of cases (female to male ratio of 4:1). The mean ages of patients diagnosed with different thyroid cancers were: papillary thyroid cancer, 39.6 years; follicular thyroid cancer, 43.2 years; medullary thyroid cancer, 55.8 years; and anaplastic thyroid cancer, 46.0 years. Papillary thyroid cancer was diagnosed in 88 cases (77%), follicular thyroid cancer in 19 cases (17%), medullary thyroid cancer in 5 cases (4%), and anaplastic thyroid cancer in 2 cases (2%). Conclusion: Thyroid cancers are more common among females. The disease is diagnosed at a relatively young age among our patients (40 years). Papillary thyroid cancer is the most common type of thyroid cancer.
, Abdulaziz F. Al-Kaabbab, Muaawia Ahmed Hamza, Abdullah A. Saeed, Abdulshakour Abdalla, May F. AlMohareb, Hana S. Alfaleh, Gwiria M. H. Satti
Open Journal of Endocrine and Metabolic Diseases, Volume 06, pp 102-108;

Objectives: The aim of this study was to investigate the relationship between the levels of 25-hydroxyvitamin D and the adipokine resistin in Saudi diabetic patients and those at high risk to develop atherosclerotic cardiovascular diseases. Methodology: One hundred and sixty seven subjects were recruited for the cross-sectional study at King Fahad Medical City, Saudi Arabia. Blood samples were analyzed for biochemical parameters. Serum 25-hydroxyvitamin D and resistin levels were measured for all the participants. Result: Fifty six type-1, 55 type-2 diabetic patients and 56 healthy controls were recruited. Serum 25-hydroxyvitamin D level in the control group was 44.21 ± 41.80 μg/ml compared to 50.67 ± 35.60 μg/ml in the diabetic group (P = 0.427) with no significant different between type-2 diabetes mellitus and type-1 diabetes mellitus (P = 0.628). Resistin level in the control group was 14.00 ± 7.39μg/ml compared to 20.21 ± 16.94 μg/ml in the diabetic group (P ≤ 0.01), no significant difference between type-2 diabetes mellitus and type-1 diabetes mellitus (P = 0.817). Resistin in those taking vitamin D supplementation was 21.34 ± 18.27 μg/ml; and in those not taking vitamin D supplementation, it was 17.4 ± 11.19 μg/ml; (P = 0.237). There was significant negative correlation between 25-hydroxyvitamin D and resistin in type-2 diabetes mellitus (P ≤ 0.043) and no significant correlation was found between vitamin 25 (OH) D and resistin level in type-1 diabetes mellitus (P = 0.538). Blood urea and creatinine showed significant positive correlation with vitamin 25 (OH) D in one hand and resistin level on the other hand. Discussion and Conclusions: Several in vitro and in vivo studies have confirmed that the vitamin 25 (OH) D have numerous important functions in the body. The circulating vitamin 25 (OH) D and resistin levels were associated with general inflammation in renal diseases. This study showed significant negative correlation between resistin level and vitamin 25 (OH) D in type 2 diabetes mellitus reflecting their roles in glucose homeostasis. The positive correlation of resistin and vitamin D with urea may reflect their involvement in kidney dysfunction. The level of serum resistin showed slight increase in diabetic patients compared to control group and it was higher in type-2 diabetes mellitus. More efforts are needed to explore the physiological mechanism of vitamin 25 (OH) D and resistin action in metabolic disorders.
Ghada M. El-Sagheer, Asmaa Kasem, Iglal M. Shawky, Ahmed Abdel-Fadeel
Open Journal of Endocrine and Metabolic Diseases, Volume 06, pp 109-119;

Background: Although recent meta-analyses indicates a consistent significant inverse relation of serum 25 (OH) D and the prevalence of gestational diabetes mellitus (GDM), the mechanism is unclear and conflicting opinions continue to be reported. Objectives: The objectives are: 1) comparison of vitamin D status in diabetic and non-diabetic pregnant women; 2) trying to determine the level of vitamin D associated with GDM, and its sensitivity and specificity; 3) determination of the relation of hypovitaminosis D with insulin resistance. Subjects and Methods: One hundred consecutive pregnant women (<28 weeks gestational period) from the attendants of the out-patient clinic at our hospital were diagnosed for GDM by glucose tolerance test (GTT) (75 g 2 h). Among them, 40 patients met the inclusion criteria for this study (group I). As a comparative group, another 40 pregnant ladies were included, 20 of them (group II) had pre-gestational type II DM, and the other 20 (group III) had normal glucose tolerance (NGT) as a control. For all the participants, we estimated fasting blood glucose, fasting serum insulin, homeostasis model assessment of (HOMA-IR and HOMA-B), quantitative insulin sensitivity check index (QUICKI), and serum 25-OH vit D. The ROC curve analysis was used to determine the optimal threshold value of vit D in relation to DM. Results: Compared to the control group, the diabetic patients showed a statistically significant increase in the levels of fasting glucose, 1-hour postprandial glucose, 2-hour post prandial glucose, fasting insulin, and HOMA-IR, (P=0.000 for all). None of the diabetic patients showed optimal vit D level. Vit D insuficiency (10 - 29 ng/ml) was found in 32.5% of patients in group I, 55% in group II, and 50% in group III. Vit D deficiency (<10 ng/ml) was found in 67.5% of patients in group I, 45% in group II, and 0% in group III. Significant negative correlation was found for vit D with fasting insulin and FBS. The AUC for 25 OH vit D was 97%, CI was 95% and p-value was 0.0001. The sensitivity, specificity, and positive and negative predictive values of 25 OH vit D in GDM versus control persons were 97%, 90%, 95.1%, 94.7% respectively at a cut-off level <22 ng/ml. Conclusions: Although it might seem premature to draw a sharp relation between hypovitaminosis D and GDM, this study showed the importance of vit D in GDM, the need for supplementation below 22 ng/ml, and the role of hypovitaminosis D in increasing insulin resistance. Further randomized studies with vit D supplementation are recommended.
Mohammad-Ali Ghaffari, Seyedeh-Arefeh Payami, Seyed-Peyman Payami, Damoon Ashtary-Larky, Abdolrahim Nikzamir,
Open Journal of Endocrine and Metabolic Diseases, Volume 06, pp 95-101;

Clinically, determination of insulin resistance is important for diabetic patients. We evaluated the relationship among 20/(fasting C-peptide × fasting plasma glucose), HOMA-IR and QUICKI indices in type 2 diabetic patients. The study included 40 patients with type 2 diabetes. Patients divided into three groups based on their medication: metformin, metformin + glibenclamide and metformin + glitazone. Fasting blood sugar, and lipid profile were measured by enzymatic method, serum insulin, and C-peptide were measured by ELISA method. Insulin resistance was calculated by using of 20/(fasting C-peptide × fasting plasma glucose), HOMA-IR and QUICKI indices. There was no significant relationship between 20/(fasting C-peptide × fasting plasma glucose) index and other parameters in all studied groups except QUICKI in metformin group showed a significant correlation with 20/(fasting C-peptide × fasting plasma glucose) index (r = 0.56 and p = 0.03). There was a significant correlation between HOMA-IR and QUICKI indices in all studied groups. There was no significant relationship between 20/(fasting C-peptide × fasting plasma glucose) index with other clinical parameters. On the other hand, our data strongly suggested a significant correlation between HOMA-IR and QUICKI indices in studied subjects with type 2 diabetes.
Bruna De Souza Faustino, Alberto Dos Reis Costa Junior, Letícia Nascimento Medeiros Bortolon, Larissa Bianca Paiva Cunha de Sá, Denise Rosso Tenório Wanderley Rocha,
Open Journal of Endocrine and Metabolic Diseases, Volume 06, pp 87-94;

The sodium and glucose co-transporter inhibitors type 2 (SGLT2) comprises a new class of hypoglycemic drugs to control type 2 diabetes mellitus, in an attempt to add new non-existing benefits to the so far arising classes. Regarding this new class of drugs, represented by dapaglifozin, canaglifozin and empaglifozin, it is important to highlight the benefits brought by these medications to combat hyperglycemia with insulin-independent mechanisms that are beyond glucose reduction, such as cardiovascular events prevention, reduction in HbA1c, weight loss and blood pressure lowering. Recently, a relevant study (Empa-Reg) brought hope and set the spotlight on the prevention of cardiac events among diabetic patients, which is the main cause of mortality within this group. However, despite coming out as a good treatment option, SGLT2 inhibitors are under constant clinical research and, as a new drug, it should be carefully carried out regarding the long-term effects of glycosuria and other possible side effects, such as the observed increase in the incidence of bladder, breast cancer and bone fractures, which require further studies. Therefore, these compounds might represent a landmark approach for the treatment of diabetes.
Milton Rodrigo Lafuente Covarrubias, Luis Fernando De Azevedo Piovezani, Frederico Martins Cordeiro, William Cabrera Viana, Mirella Hansen de Almeida, Denise Rosso Tenório Wanderley Rocha,
Open Journal of Endocrine and Metabolic Diseases, Volume 06, pp 78-86;

Short stature is a clinical challenge in the daily practice of pediatric endocrinology, regarding the several technical, cultural and economic factors associated with its approach. This article intends to review the physiology of growth hormone secretion, the endocrine regulation of human growth and the clinical aspects of the diagnosis and treatment of short stature. It specifically analyses the treatment of short stature with growth hormone, along with its side effects, cost/benefit analysis and possible risks. A clinical case from a medical school is also described, intending a better understanding of this frequent ambulatory situation in endocrinology and pediatrics.
Deise Dutra Terra Carvalho, Denise Rosso Tenório Wanderley Rocha,
Open Journal of Endocrine and Metabolic Diseases, Volume 06, pp 72-77;

Juvenile hypothyroidism is an unfrequent form of hypothyroidism that affects children. If not diagnosed and treated properly, it may cause severe neurological disorders during growth. The most frequent difficulties are found in school performance, difficulties in concentration, hyperactivity or fatigue and damage on the onset of puberty. Starting levothyroxine as a drug of choice is essential, and it should be made according to the age and weight of the child. Laboratory tests for control should be requested periodically, along with a strict control of the child’s development and growth. The family-doctor relationship, along with a clear guidance on the importance of treatment, is critical to achieve a successful treatment. This article is a review about the main clinical features of hypothyroidism in childhood, especially in developing countries, providing key aspects of adherence and characteristics of its follow-up.
João Zallio Coelho, Pedro Julião Zallio Coelho, Sanchela Raiane Pereira de Oliveira, Alex Farias Soares, Jacqueline Novais Santana, Paulo Ricardo Bacelar Macedo, Juliana Silveira de Freitas, Danilo Guimarães Nogueira Andrade, Mirella Hansen de Almeida, Denise Rosso Tenório Wanderley Rocha, et al.
Open Journal of Endocrine and Metabolic Diseases, Volume 06, pp 66-71;

Diabetes Mellitus is one of the most prevalent diseases in the world. In Brazil, 8.7% of the population between 20 and 79 years of age has diabetes, estimating 11.6 million diabetics. It is commonly associated with other co-morbidities such as hypertension, dyslipidemia and obesity, which put these patients into a high cardiovascular risk profile. This study was performed using the medical records of enrolled population attending a Family Health Unit of Alto do Coqueirinho, Salvador, Northeastern Brazil, consisting of one doctor, one nurse, one dentist, one nursing technician and six community health workers. Medical records and data provided by the system of the Primary Care Information (SIAB), showed total of 2495 patients. Considering the prevalence morbidities in this population, hypertension was present in 9.8% of patients and Type 2 Diabetes in only 3.6%. Since the prevalence of morbidities is the key indicator to the development of public health policies, it seems important a better knowledge on the prevalence rates of diabetes, prediabetes and its co-morbidities of this population. Future plans and projects for health professionals will be based on a consistent medical record.
Guilherme Barbosa, Larissa Bianca Paiva Cunha de Sá, Denise Rosso Tenório Wanderley Rocha,
Open Journal of Endocrine and Metabolic Diseases, Volume 06, pp 58-65;

The polycystic ovary syndrome (PCOS) is defined as a combination of hyperandrogenism (hirsutism and acne) and anovulation (oligomenorrhea, infertility, and dysfunctional uterine bleeding), with or without the presence of polycystic ovaries on ultrasound. It represents the main endocrine disorder in the reproductive age, affecting 6% - 15% of women in menacme. It is the most common cause of infertility due to anovulation, and the main source of female infertility. When in the presence of a menstrual disorder, the diagnosis of PCOS is reached in 30% - 40% of patients with primary or secondary amenorrhoea and in 80% of patients with oligomenorrhea. PCOS should be diagnosed and treated early in adolescence due to reproductive, metabolic and oncological complications which may be associated with it. Treatment options include drugs, diet and lifestyle improvement.
Lis Marina De Mesquita Araújo, Sumaya Feguri, Thereza Lopes de Oliveira, Fernanda Batista Pedrosa, Rodrigo Garcez Guimarães, Larissa Bianca Paiva Cunha de Sá, Denise Rosso Tenório Wanderley Rocha,
Open Journal of Endocrine and Metabolic Diseases, Volume 06, pp 43-57;

GLP-1 receptor agonists are approved for the treatment of type 2 diabetes, and more recently for obesity treatment. The glucagon-like-peptide-1 (GLP-1) is a glucose dependent hormone produced by intestinal cells, which is involved in insulin secretion and glucagon suppression. This hormone controls glucose plasma levels and reduces food intake. Additional effects were reported in slowing gastric emptying and in inducing satiety. In clinical practice, theGLP-1 receptor agonists are associated with significant reductions in glycosylated hemoglobin (HbA1c) and weight loss, despite showing a low risk of hypoglycemia. Beneficial effects have also been observed on blood pressure and lipid profile. The most common side effects associated with GLP-1 receptor agonists are gastro-intestinal motility disorders, such as nausea, vomiting and diarrhea, which are not associated with long-term health risks. Therefore, GLP-1 receptor agonists represent a relevant medication for type 2 diabetes, whose benefits may go far beyond glycemic control.
Sarah Virgínia Dantas Guimarães, Heldernilson Lopes Eugênio Gomes, Claudio Galindo de Oliveira, Marcus Fabiano Santana Rocha Chiacchio, Fabricio Miranda Souza, Daniel Souza Oliveira, Renata Lima de Cerqueira, Jurandir José Cerqueira Dantas Junior, Denise Rosso Tenório Wanderley Rocha,
Open Journal of Endocrine and Metabolic Diseases, Volume 06, pp 38-42;

Cholelithiasis is a common disease in the general population. One of its risk factors is the type 2 diabetes mellitus, related to metabolic abnormalities associated to overweight, obesity, insulin resistance, hypertriglyceridemia and dietary habits. The main risk factors to cholelithiasis are genetic susceptibility, ileum resection, diabetes mellitus, obesity, hemolytic anemia, age, estrogens and cirrhosis. This study aims to make a correlation between diabetes mellitus and obesity versus prevalence of cholelithiasis in these patients.
Cintia Linhares e Souza, Larissa Bianca Paiva Cunha de Sá, Denise Rosso Tenório Wanderley Rocha, Alberto Krayyem Arbex
Open Journal of Endocrine and Metabolic Diseases, Volume 06, pp 1-7;

Vitamin D deficiency and Diabetes are both disorders of high prevalence in the world. Currently, evidences suggest a possible correlation of low levels of vitamin D with the diagnosis of Diabetes Mellitus. Hypovitaminosis D could be associated with insulin resistance and Diabetes Mellitus, which would in part explain mechanisms involved in the pathogenesis of Diabetes. The aim of this work is to discuss the association between Vitamin D and Diabetes, questioning if vitamin D can prevent the settlement of diabetes or slow down its clinical evolution, and improve the pancreatic function, thus providing a better glycaemic control.
Letícia Nascimento Medeiros Bortolon, Luciana De Paula Leão Triz, Bruna De Souza Faustino, Larissa Bianca Cunha de Sá, Denise Rosso Tenório Wanderley Rocha, Alberto Krayyem Arbex
Open Journal of Endocrine and Metabolic Diseases, Volume 06, pp 13-19;

Gestational mellitus diabetes (GDM) is a highly prevalent metabolic disorder among pregnant women nowadays. It is defined as any level of glucose intolerance, appearing or first being recognized during pregnancy. It is essential to diagnose and treat GDM early, in order to reduce or avoid complications for mother and fetus. Recently, new guidelines have changed the diagnosis criteria, and it is expected that the prevalence of GDM will increase by approximately 18%. A relevant goal of these new definitions is to provide a better care for pregnant women, in an attempt to reduce fetal and maternal complications. These new criteria will also increase the impact on costs of the health care system. Treatment must be individualized for best results, including a specific diet, physical activity and the use of medications. Metformin and Insulin use are analyzed in detail, in face of new evidences regarding their safety and efficacy during pregnancy.
Taiwo Hussean Raimi, , Olatunde Odusan, Augustine Efedaye Ohwovoriole
Open Journal of Endocrine and Metabolic Diseases, Volume 05, pp 184-192;

Objective: To determine the best index of central obesity that predicts cardiovascular risk factors (general obesity and hypertension). Methods: A cross-sectional study involving nine hundred and sixteen (443 males and 473 females) participants of a community health survey in Sagamu and Remo-North Local Government Areas of Ogun State, Nigeria. The body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) of the participants were determined by standard protocols. Pearson correlation between BMI and the three central obesity indices was determined. The area under curve (AUC) on the ROC was used to determine the best measure of central obesity which identified individuals with general obesity and hypertension. Results: WHtR and WC were better than WHR at detecting the presence of both general obesity and hypertension in both males (WHtR vs WHR {difference in areas = 0.131} p < 0.0001; WC vs WHR {difference in areas = 0.132} p < 0.0001), and females (WHtR and WHR {difference in areas = 0.214} p < 0.0001; WC and WHR {difference in areas = 0.205} p < 0.0001). Conclusions: WHtR is as good as WC but better than WHR in identifying individuals with cardiovascular risk factors, and may also be a good criterion to diagnose metabolic syndrome.
Pondugala Pavan Kumar, Gaddipati Radhika, G. Venkat Rao, D. Nageshwar Reddy, M. Sasikala
Open Journal of Endocrine and Metabolic Diseases, Volume 05, pp 177-183;

Background/Aim: Islet regeneration in chronic pancreatitis (CP) is relevant for managing the associated loss of endocrine function. Because ductal epithelial cells were earlier demonstrated to differentiate into pancreatic endocrine mass, we evaluated their proliferation and differentiation in chronic pancreatitis. Methods: Pancreatic ducts were obtained from surgically resected pancreata of 12 patients with chronic pancreatitis and 15 control subjects. CK19 positive ductal cells were evaluated for their proliferating and differentiating abilities upon immunostaining with Ki 67 and hormone positivity for insulin and glucagon, apart from monitoring Pdx 1 expression. Results: In comparison to the controls, a greater number of proliferating pancreatic ductal epithelial cells (PDECs) were observed under conditions of CP. The increase in Pdx1 expressing PDECs (22%) and proliferating Pdx1 expressing PDECs (30%) was significant (P < 0.04). Number of cells expressing insulin/glucagon in the exocrine ducts increased significantly in CP as compared to controls (P < 0.02) and β cell mass adjacent to the ducts increased by 28%. Conclusion: Enhanced capability of PDECs to proliferate and differentiate into endocrine mass suggests that PDECs form a source of progenitors for cell based therapy in chronic pancreatitis.
Jianjun Yang, Hongyan Qiu, Hongyu Li, Yuhong Zhang, Xiujuan Tao, Yanna Fan
Open Journal of Endocrine and Metabolic Diseases, Volume 05, pp 163-170;

A growing number of studies show that different countries and populations require different cut-off points for body mass index (BMI), and waist circumference (WC) leading to obesity. There are no data on optimal cut-off points to metabolic syndrome (MS) among urban residents in Ningxia. Our aim is to determine the appropriate cut-off points for BMI and WC associated with elevated prevalent MS risk among urban residents in Ningxia. A total of 2500 urban residents in Ningxia were examined from May 2008 to March 2009 in a community-based cross-sectional study. Height, body weight, waist circumference and hip circumference were measured to calculate BMI. Fasting blood glucose (FBG), plasma levels of triglyceride (TG), total cholesterol (TC), and high-density lipoprotein cholesterol (HDL-C) were examined using a blood glucose meter and the chromatographic enzyme method. BMI and WC were measured to assess overweight or obesity. Of these, 301 subjects were chosen according to metabolic syndrome diagnosis standards to form the case group. The control group comprised 301 healthy people without diabetes, hypertension, hyperlipemia, coronary heart disease, cerebrovascular disease, malignant tumors or chronic infections. Logistic regression and receiver-operating characteristic (ROC) curve analyses were used to determine optimal cut-off points for BMI and WC in relation to the area under the curve (AUC), sensitivity and specificity. The optimal cut-off points for male and female respectively were 24.78 kg/m2 (sensitivity = 0.879, specificity = 0.648) and 24.72 kg/m2 (sensitivity = 0.804, specificity = 0.767) for BMI, 85.95 cm (sensitivity = 0.701, specificity = 0.641) and 78.25 cm (sensitivity = 0.804, specificity = 0.528) for WC. Urban residents in Ningxia were at high risk of MS, and the cut-off points for BMI and WC were lower than the data currently recommended in Asian population.
Estrella Diego, Andreea Ciudin, Olga Simo-Servat, Angel Ortiz, , Jordi Mesa
Open Journal of Endocrine and Metabolic Diseases, Volume 05, pp 171-176;

A 39-year-old woman consulted in the postpartum period because of agalactia, polyuria, polydipsia, and headache and decreased visual acuity. The initial analysis was compatible with a panhypopituitarism. The magnetic resonance (MRI) showed an expansive sellar and suprasellar lesion of high density in the basal study and enhancement after contrast administration, in contact with the optic chiasm, so urgent surgery was indicated. While waiting for the surgery, intravenous corticosteroids were initiated and the symptoms rapidly resolved. Most of the pituitary axes were recovered, except the diabetes insipidus. The control MRI showed complete resolution of the sellar mass. The surgery was canceled and the diagnosis of lymphocyte hypohpyisitis was made. Lymphocyte hypophysitis is an uncommon disease in which inflammation of the pituitary gland occurs. This results in a permanent or transient hormonal insufficiency. Lymphocyte hypophysitis is a very rare condition that occurs preferentially in women in the peripartum period. Early initiation of high doses of systemic corticosteroids may avoid unnecessary surgery in some cases.
Abdulmonim A. Alqasim, Sami H. Hammadi, Ghazi Bamagous, Essam Eldin M. Noureldin, Hussam H. Madi
Open Journal of Endocrine and Metabolic Diseases, Volume 05, pp 149-161;

Objectives: The aim of this study is to compare the efficacy of the anti-angiotensinic drug, ramipril and irbesartan on the vascular protection of kidneys of streptozotocin (STZ)-induced diabetic rats (DR). Methods: 110 male albino rats were divided into 7 main groups. Group-1 (10 normal control rats; NC). Group-2 (10 rats) was injected intra-peritoneally with STZ (Diabetic Rats; DR). Group-3 (10 DR) is controlled by insulin. Groups 4 to 7 (20 DR), each is subdivided into two subgroups that received either low or high dose of ramipril or irbesartan with or without insulin. Two months post treatment, rat-tail blood was collected to measure: Fasting blood sugar, HbA1c, total serum proteins, albumin and lipid profiles. Urine was collected to measure albuminuria. Kidneys were isolated for histopathological study. Results: Biochemically, both ramipril and irbesartan (without insulin) lowered albumin concentration in urine samples especially at high doses. Histopathologically, there is no beneficial response of both drugs without insulin. Combination of insulin together with either drug has beneficial effects biochemically and histopathologically at high doses. Low dose irbesartan only has renoprotective effect in DR treated with insulin. The other biochemical parameters showed negligible response to both drugs. Conclusion: Low dose irbesartan and high doses of both drugs have renoprotective effect in DR treated with insulin.
Open Journal of Endocrine and Metabolic Diseases, Volume 05, pp 138-147;

Objective: This study was performed to analyze the modifications within adipose tissue during calorie restriction and more specifically to state whether hysteresis occurs during fat mass reduction. Method: Rats male Wistar increased their body weight by 130 g under control conditions and were then submitted to a calorie restriction (CR) at 30% or 60% of control. Experiment has been stopped when the body weight of the group CR60% returned back to its initial value. Samples of retroperitoneal adipose tissue were collected by biopsies along the study. Adipose cell size was analyzed using multisizer IV (Beckman Coulter) to determine the size distribution curves during natural growth and after calorie restriction. Results: After CR60%, body weights and adipose tissue masses were similar to the ones at the beginning of the experiment. Adipose cell size distribution curve was shifted to the left compared to the one of initial control. Adipose cell sizes were significantly lower after CR60% than those of control at the beginning of the experiment. Conclusions: These results state for the first time that hysteresis occurs in white adipose tissue after calorie restriction. The composition of adipose tissue after calorie restriction was significantly different than the one of initial control. After significant weight loss, organisms must be considered as different from the initial controls, they are most likely governed by different regulations which will have to be identified.
, , Fernanda Picolo, Suelma Beatriz Marques Prata Tavares, , , Debora Cristina Damasceno Meirelles dos Santos, Paulo Adão de Campos, Iracema De Matos Paranhos Calderon,
Open Journal of Endocrine and Metabolic Diseases, Volume 05, pp 124-130;

Metabolic syndrome is an epidemic that affects more and more people, increasing the probability of suffering metabolic and cardiovascular diseases in the short, medium or long term depending on the severity. The purpose of this article is to review the metabolic syndrome, assessing consensus, controversy and prevalence. The methodology was the preparation of a literature review on various health care databases, which were from 43 articles published from 2010 to 2015, in the general population. SM rate ranges from 0% to 90% depending on genders, ages and regions. There is still lack of consensus on cutoffs of diagnostic criteria. Thus, it is concluded that the prevalence of metabolic syndrome is being increased, urging the need for early diagnosis and treatment to promote the health of the global population.
James L. Cox, Yingzi Chang,
Open Journal of Endocrine and Metabolic Diseases, Volume 05, pp 105-116;

Dehydroepiandrosterone (DHEA) is a weak androgen and is shown to have anti-cancer, anti-atherogenic, anti-adipogenic and anti-inflammatory effects on mouse, rat and rabbit models. However, human clinical trials data did not support animal findings and were inconclusive. These systemic differences in biological actions between rodents and humans were attributed to the low level of DHEA in rodents. In order to further understand the differences in biological functions between rodents and humans, we resorted to an in-vitroapproach involving mouse, rat and human cell lines to assess DHEA biological and anabolic functions separately and independently without systemic influence. Results indicated that DHEA was effective on mouse and rat cell lines but not on human cell lines, as observed in in-vivo studies. In addition, our in-vitrostudy showed that DHEA was able to induce myogenesis in mouse mesenchymal cells revealing its anabolic function, even though DHEA was considered as a weak androgen. This observation lent credence to the ban on DHEA by IOC medical commission, citing DHEA as an anabolic steroid. These in-vitro experiments suggested that the differences in biological actions of DHEA between rodents and humans existed not only in-vivo at the systemic level, but also in-vitro at the cellular level and thus paving the way to study the mechanism responsible for these differences at the cellular level itself.
Open Journal of Endocrine and Metabolic Diseases, Volume 05, pp 84-87;

Coconut oil (CO) has generated discussions about its possible effects on health, especially for being an oil rich in saturated fat, which is known to contribute to the development of atherosclerosis and cardiovascular diseases. On the other hand, CO contains high levels of lauric acid that is directly absorbed by enterocytes and may prevent the fat deposition in blood vessels. In addition, flavonoids and polyphenols present in CO may be beneficial in reducing the oxidative stress involved in the etiology of various diseases, for instance, cardiovascular diseases and cancer. This article aimed to review the likely benefits of CO and its effects related to oxidative stress, hyperlipidemia and chronicle diseases in humans.
Open Journal of Endocrine and Metabolic Diseases, Volume 05, pp 88-97;

Hypertension (HTN) is the risk factor that most contributes to mortality rates in the world, followed by physical inactivity and obesity. Despite the influence of genetic factors on the genesis of HTN, blood pressure levels are strongly influenced by environmental factors such as physical inactivity and overweight, characterizing it as a polygenic disease. Genetic components and environmental factors such as physical exercise may modulate the phenotype of individuals predisposed to medical conditions such as HTN, independently of modifiable factors such as increased levels of adiposity; however, studies have shown that polymorphic forms detected in genes involved in the mechanisms of blood pressure regulation and also related to body fat modulation may interact with physical activity levels and HTN. The aim of this article is to review the interactions between polymorphisms in ADRB2, ADRB3, BDKRB2 and MTNR1B genes, physical activity and blood pressure.
Kuang-Chung Shih, Sheng-Hwu Hsieh, Chii-Min Hwu, , Szu-Han Chiu, Yu-Ching Chou,
Open Journal of Endocrine and Metabolic Diseases, Volume 05, pp 55-63;

The purpose of this study was to investigate the involvement of growth hormone in the diurnal variation of insulin sensitivity in healthy adults. Afternoon (16:00 hr) or night (23:00 hr) pretreatment with a subcutaneous injection of normal saline, human growth hormone to mimic the normal nocturnal rise in growth hormone, or octreotide to inhibit endogenous growth hormone secretion to create a state of relative nocturnal growth hormone deficiency, was given 16 hours before undergoing the modified insulin suppression test in healthy subjects. The morning and evening experiments were separated by an interval of at least 3 days. Thus, each subject was tested on six separate occasions arranged in a random order. A higher value of the steady-state plasma glucose (SSPG) is indicative of lower insulin sensitivity. Plasma glucose, serum insulin, insulin-like growth factor-1, nonesterified fatty acids (NEFA), and metabolic clearance rate of insulin (MCRI) were measured. In the normal saline and human growth hormone groups, SSPG levels were lower in the morning than in the evening. Evening SSPG levels, MCRI, and NEFA concentrations were higher in the participants treated with normal saline and growth hormone than in the octreotide group. Differences in SSPG levels between the morning and evening values were higher in the participants pretreated with normal saline and growth hormone than in those treated with octreotide. A diurnal variation in insulin sensitivity existed in healthy subjects. These results provided direct evidence that the role of growth hormone in regulating insulin sensitivity might be related to changes in the MCRI and the metabolism of NEFA in healthy subjects.
, Giovana Baldissera, , Thiago Gomes Heck,
Open Journal of Endocrine and Metabolic Diseases, Volume 05, pp 65-76;

The Metabolic Syndrome (MetS) is a complex condition which is characterized by increased risk factor for cardiovascular diseases, such as dyslipidemia, hypertension and central obesity, in addition to increased risk for type 2 diabetes mellitus (T2DM). All of these factors alone have a notable relationship with DNA damage. However, when the risks are combined, the extent for major outcomes being related to DNA damage (cancer), the consequence can be accelerated by the metabolic dysfunction. This article will illustrate the scientific evidence of the role of DNA damage in MetS, as well as discuss the interplay of major risks factors (air pollution, physical inactivity and dietary interventions) in genomic stability.
Open Journal of Endocrine and Metabolic Diseases, Volume 05, pp 77-83;

Avocado is a fruit which had a caloric density of 1.7 kcal per gram and a half unit (~70 g) is composed by 114 kcal, 4.6 g of fibers, 345 mg of potassium, 19.5 mg of magnesium, 1.3 mg of vitamin E and 57 mg of phytosterols. Approximately 75% of fiber’s avocado contents are considered insoluble and 25% are soluble. The avocado contains lipids that consist of 71% from monounsaturated fatty acids (MUFA), 13% from polyunsaturated (PUFA) and 16% from saturated fatty acids (SFA). Recent researches have shown that avocado may improve hypercholesterolemia and may be useful in the treatment of hypertension and type 2 diabetes mellitus (T2DM). This way, avocado plays an important role in the cardiovascular health. This review summarizes the potential benefits of avocado consumption in the prevention of cardiovascular risk factors and metabolic diseases.
, Vagner Rosa Bizarro, Julio Cesar Salles Santos, Lis Marina Mesquita Araújo, Ana Luísa Conceição de Jesus, Minelli Salles Alves Fernandes, Marcela Miranda Salles, Denise Rosso Tenório Wanderley Rocha,
Open Journal of Endocrine and Metabolic Diseases, Volume 05, pp 98-104;

Linoleic (LA) and α-linolenic acids (ALA) are considered essential fatty acids (EFA) because they are not produced by the human body. This way, EFAs sources must come from the diet. The primary dietary source of n-3 fatty acids is ALA, found in seeds and seed oils. Other important sources are fish oils such as tuna, salmon and herring. Currently, numerous studies suggest possible benefits of essential fatty acids in human health, such as in cardiovascular, cognitive and eye health, and also during pregnancy and childhood. This paper also discusses the impact of fatty acids in human metabolism, and the available evidence regarding its risks. It addresses the relevant debate regarding a general ban of trans fatty acids (TFA) from the world food market, because of the cardiovascular risks associated with its consumption.
Dalim Ki,
Open Journal of Endocrine and Metabolic Diseases, Volume 05, pp 51-53;

Introduction: Polyuria is a sign for many disease processes, including diabetes mellitus and diabetes insipidus. Urine osmolarity helps distinguish osmotic diuresis caused by diabetes mellitus from water dieresis induced by diabetes insipidus. Case Presentation: We report a case of a 48-year-old woman who presented with polyuria, polydipsia, nocturia, and weight loss after a return from a visit to Russia, during which she received a five-day course of antibiotic Demeclocycline, a tetracycline derivative for dental treatment. She recovered from all clinical manifestations by 8 weeks. Conclusion: Manifestation of transient nephrogenic diabetes insipidus is induced by Demeclocycline.
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