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Background The efficacy of dapagliflozin has been less extensively studied in the real-life context, limiting the comparability of observational real-world evidence with results from dapagliflozin clinical trials. This study aimed to evaluate HbA1c, blood pressure (BP), and weight outcomes in dapagliflozin-treated patients with type 2 diabetes (T2D) treated in a real-world setting. Methods A total of 1683 T2D patients (mean (SD) age: 54.6 years (9.1), 56.6% were females) initiating dapagliflozin were included in this multicenter retrospective observational cohort study. Data on patient demographics, comorbidities, duration of diabetes, and concomitant antidiabetic treatment were recorded. Change in glycated hemoglobin (HbA1c), body weight, body mass index (BMI), and BP levels with dapagliflozin treatment and dapagliflozin discontinuation rates were evaluated based on baseline, 3rd-month, and 6th-month data. Results At the end of 6-month dapagliflozin treatment (discontinued in 4.3% of patients), HbA1c levels were 5% weight loss was evident in 38.0% of patients. Less than 5-year diabetes duration was associated with significantly higher rate of achieving HbA1c

Adrenal incidentalomas are clinical dilemmas for the clinicians. The work up, to differentiate between malignant and benign lesions, and hyperfunctioning and nonfunctioning lesions is mandatory before the consideration of surgical resection. Ectopic thyroid tissue located in the adrenal gland (ETTAG) is a very rare condition. We report a case of ETTAG presenting with adrenal incidentaloma. A 57-year-old woman was admitted with incidental right adrenal mass. Hormone evaluation showed no hormonal activity. Magnetic resonance imaging revealed a 20x17 mm lobulated solid mass, which contained millimetric hypointense nodular areas consistent with calcifications. Loss of signal intensity on out-of-phase could not be evaluated because of the calcifications. Right adrenalectomy was performed to establish the histopathological diagnosis and to rule out malignancy. Histopathological diagnosis revealed ETTAG. Her medical history was positive for multinodular goiter and bilateral subtotal thyroidectomy 32 years ago. Thyroid ultrasonography showed residual thyroid tissue in both the right and left lobes, and colloid thyroid nodules. Fine needle aspiration biopsy from the nodules revealed benign nodules. The patient has been followed up for six years, and no change in thyroid nodule sizes and no evidence of metastatic foci have been detected. ETTAG would be considered in the differential diagnosis of adrenal mass showing no hormonal activity, especially when magnetic resonance images are not consistent with adrenal adenoma. Long follow-up duration of this case suggests that it was a benign condition.

The incidence of cystic fibrosis-related diabetes (CFRD) has increased, since the life expectancy of cystic fibrosis (CF) patients continues to improve. CFRD increases the mortality in patients, because of the negative impacts of CFRD on pulmonary functions. Knowledge of the pathogenesis and course of the disease is essential to administer the appropriate therapy. A thirty-one-year-old CFRD patient, who had hypoglycemia and weight loss under the calorie restriction diet and basal insulin therapy, was admitted to the Endocrinology Department for revision of her therapy. A high-calorie diet considering increased energy demand and multiple insulin injections according the carbohydrate counting were administered to the patient. She gained weight and target blood glucose levels were achieved as a result of this therapy. We present the first case with CFRD followed in our clinic with the review of the literature about the pathogenesis, course and therapy of this disease to draw attention to a special kind of diabetes, which we will encounter more frequently. Turk Jem 2012; 16: 74-8

Background: This study has been undertaken to investigate the possible alterations of oxidant/antioxidant status in uremic patients undergoing hemodialysis (HD) and the effects of vitamin E supplementation. Methods: Erythrocyte antioxidant enzyme activities [glutathione peroxidase (GSHPx), superoxide dismutase (SOD) and catalase (CAT)] and thiobarbituric acid reactive substance (TBARS) concentrations as a measure of lipid peroxidation in HD patients have been determined and compared with healthy controls. The patient group consisted of 36 uremic patients 21-75 years of age undergoing maintenance HD three times weekly for an average of 41 months. The efficiency of Vitamin E therapy in dialysis patients was also assessed by re-evaluating antioxidant status of the same patients after supplementation of the vitamin E in a dosage of 600 mg/daily for 14 weeks. Results: A significant decrease in the activities of erythrocyte SOD, CAT and GSHPx and a significant increase in TBARS concentrations were found in patient group compared to control group (p < 0.001). A significant correlation between GSHPx activities and duration of HD therapy was also observed (r= - 0.46,p < 0.01). Vitamin E supplementation caused an increase in GSHPx and SOD activities and a decrease in TBARS concentrations. A slight but not significant increase in CAT activity was also observed by Vitamin E. Conclusions: The results suggest the presence of an oxidative activity and the possible preventive role of Vitamin E therapy in uremic patients undergoing HD. (C) 2003 Elsevier B.V. All rights reserved.

'Non-dippers' are individuals without the anticipated nocturnal decrease in blood pressure. An increased incidence of target organ damage and a worse outcome in terms of cardiovascular events have been reported in this group of people. The pathogenesis of non-dipper hypertension is not clear at present. We aimed to investigate the effects of overt and subclinical hypothyroidism on the development of a non-dipper blood pressure pattern via 24-hour ambulatory blood pressure monitoring.109 normotensive patients with overt and subclinical hypothyroidism were evaluated, and 95 of these patients without reverse dipping and masked hypertension were included in the study. The control group consisted of 75 gender- and age-matched, normotensive, euthyroid healthy individuals.Median serum TSH levels were 7.61 and 1.59 mUmL in patient and control groups, respectively. The number of non-dippers according to systolic, diastolic and mean blood pressure was significantly higher in the patients with hypothyroidism compared to the control group. In linear regression analysis, TSH had a negative effect on the night/day ratio of the systolic, diastolic and mean blood pressures.Despite the fact that the effect of hypothyroidism on non-dipper blood pressure pattern is not known, the present study has revealed that elevated TSH levels are likely to increase the risk of non-dipping in normotensive patients with either overt or subclinical hypothyroidism.

SUMMARY: Renal involvement is not uncommon in rheumatoid arthritis (RA). Many RA patients have renal dysfunction either secondary to the drugs used to treat arthritis or because of the chronic inflammation. Renal pathologies have often included amyloidosis, drug-related renal disease and mesangial glomerulonephritis. However, membranoproliferative glomerulonephritis has only been rarely reported. We report a case of rheumatoid arthritis associated with membranoproliferative glomerulonephritis that rapidly progressed to end-stage renal disease.

Adipocyte fatty acid binding protein-4 (A-FABP4) and retinol binding protein-4 (RBP4) have recently been linked to type 2 diabetes mellitus (DM). Serum A-FABP4 and RBP4 levels and their relationships with early diabetic nephropathy were examined in 87 type 2 diabetic patients. The patients with diabetic nephropathy showed high A-FABP4 levels compared to the patients without diabetic nephropathy (p = 0.0001). Log A-FABP4 correlated positively with age (p = 0.02), log duration of diabetes (p = 0.04), log body mass index (BMI) (p = 0.0001), log creatinine (p = 0.007), log C-reactive protein (CRP) (p = 0.01), log albumin excretion rate (AER) (p = 0.001), and negatively with MDRD-GFR (p = 0.0001). Serum RBP4 levels were similar between the patients with and without diabetic nephropathy. RBP4 correlated positively with triglycerides (p = 0.001), log creatinine (p = 0.009), and negatively with MDRD-GFR (p = 0.04). In regression analysis, log A-FABP4 was associated with age, sex, log BMI, and log AER (r(2) = 0.43) and RBP4 was associated with triglycerides and log creatinine (r(2) = 0.22). In conclusion, we found high serum A-FABP4 but unchanged RBP4 concentrations and their associations with renal function and early diabetic nephropathy in type 2 DM. (C) 2010 Elsevier Ireland Ltd. All rights reserved.

PubMed: 19408174 Aim. This study was performed to compare the serum levels of resistin and adiponectin in women with polycystic ovary syndrome (PCOS) and normal controls. Materials and methods. Seventy-six patients (36 obese, 40 non-obese) with PCOS and 42 healthy subjects were included in the study. Serum levels of resistin, adiponectin, follicle-stimulating hormone, luteinising hormone, dehydroepiandrosterone sulfate (DHEA-S), 17-hydroxy progesterone, free testosterone, androstenedione, glucose, insulin and lipid parameters were measured. Insulin resistance and carbohydrate metabolism were evaluated by using the homeostasis model (HOMA) and the area under the insulin curve (AUCI). Results. Plasma resistin levels, HOMA-IR and AUCI were significantly higher and adiponectin level was lower in women with PCOS than those in healthy women. Plasma resistin levels were similar among obese and non-obese women with PCOS. No correlation was observed between resistin, body mass index (BMI), HOMA-IR, AUCI, insulin, lipid parameters and serum androgen levels. In obese PCOS patients, adiponectin levels were lower than in the lean PCOS patients. A negative correlation was observed among adiponectin, HOMA-IR, AUCI, BMI, testosterone, DHEAS, total-cholesterol, LDL-cholesterol and lipoprotein (a) levels. Conclusion. These results suggest that the serum adiponectin level may be involved in the pathogenesis of PCOS. But resistin levels were independently associated with insulin resistance and BMI in PCOS patients. Nevertheless, wider-scale trials are required to be performed on this subject.

Although the role of reactive oxygen species (ROS) in chronic renal failure (CRF) is not definitely demonstrated, a consistent number of observations has provided evidence for the presence of oxidative stress in uremic patients undergoing maintenance dialysis. In order to investigate this hypothesis further and to understand the role of antioxidant supplementation, peripheral blood lymphocytes were taken from 36 dialysis patients before and after Vitamin E supplementation in a dosage of 600 mg per day (2 x 300 mg) for 14 weeks and examined in the alkaline Comet assay for DNA strand breakage. The results were also compared with those of 36 controls with comparable age, sex, and smoking habits, and with no history of renal disease. The DNA breakage observed in the lymphocytes of patients before Vitamin E supplementation was significantly higher than in the controls (P < 0.001) but a clear protective effect of Vitamin E supplementation were observed after 14 weeks of therapy. (C) 2002 Elsevier Science B.V. All rights reserved.