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Background: Early prognostication of acute pancreatitis (AP) patients for those at high risk of complications during hospitalization can facilitate clinical decision-making. Sarcopenia has been proven to be a risk factor for poor prognosis in patients with AP. We aimed to evaluate the association between the muscle parameters measured in computed tomography (CT) and the clinical outcomes of hospitalized patients with AP. Methods: A total of 132 consecutive patients hospitalized between 1 January 2015 and 31 December 2021 for AP with a valid CT scan were analyzed. The first CT conducted during hospitalization was analyzed for psoas muscle area (PMA), index (PMI), and density (PMD) at the L3 vertebral level. The main adverse outcomes indicating a worse prognosis were the development of extrapancreatic complications, infections, ICU transfer, in-hospital mortality, and hospitalization length. Results: The lowest tertile of PMI, as a surrogate for sarcopenia, was significantly correlated with increased rates of extrapancreatic complications, infections, and longer hospitalizations. It was additionally correlated with a worse CT severity index. The results for PMA and PMD also showed worse outcomes, largely mirroring the results for PMI. Although in-hospital mortality was relatively low, none of the patients died in the highest tertile of PMI. A clear cutoff with sufficient predictive capability could not be found. Conclusions: A low psoas muscle index can serve as an additional potential predictive marker for more severe disease and worse outcomes in hospitalized acute pancreatitis patients. More studies are needed to determine its combination with existing prediction tools. [ABSTRACT FROM AUTHOR]

Aims: Assessing the value of oral glucose tolerance test performed at term pregnancy in identifying obstetric complications. Methods: Retrospective cohort study of women with a normal 50 g glucose challenge test who also had an oral glucose tolerance test at term (defined as at or after 37 weeks of gestation). Comparison between the pathological and normal oral glucose tolerance test groups was performed. Results: The mean glucose in the glucose challenge test of women in the normal oral glucose tolerance test (n = 256) group was lower than that in the pathological oral glucose tolerance test (N = 16) group (105 ± 17 mg/dl (5.8 ± 0.9 mmol/l) vs 117 ± 13 mg/dl (6.5 ± 0.7 mmol/l), p = 0.007). Relevant obstetrical complications did not differ significantly between the groups. Of note, in the pathological oral glucose tolerance test group only one woman delivered a macrosomic infant. Conclusions: A pathological oral glucose tolerance test performed at term was unable to identify women at risk for impaired glucose metabolism-related obstetric complications and is therefore of limited clinical value and seems to be unjustified. [ABSTRACT FROM AUTHOR]

Background The COVID-19 pandemic limits access to diabetes clinics. Remote communication by phone calls and WhatsApp messages became available in the past years. However, the current need to avoid face-to-face meetings necessitates further expansion of telemedicine services. There are limited data whether the option of virtual meetings is a preferred therapeutic modality for patients with type 1 diabetes (T1D). Objective To assess in a cohort of T1D patients, their preference and perception of telemedicine. Methods T1D patients who are followed in a hospital-affiliated diabetes clinic were asked to fill a structured questionnaire aimed to determine their attitude towards telemedicine and their preference of virtual versus conventional visits. The questionnaire was offered to consecutive T1D patients who visited the clinic between August to October 2020. Results Seventy one T1D patients that fulfilled the questionnaire were included. Median age was 38 years, 39% were male, and median duration of diabetes was 18 years. Fourteen percent of the participants preferred only virtual visits, 24% only conventional visits and 62% preferred a combination of these modalities. Sex, origin, education, duration of diabetes, mode of insulin treatment and distance from the clinic were not associated with patients' preference, but older patients (≥ 61 years) tended to prefer conventional visits. Sixty-six percent felt confident in their ability to download data from their personal medical devices. Conclusions Patients from a wide range of treatment modalities are willing to use telemedicine. However, virtual meetings cannot fully replace conventional visits in T1D especially in the older age group. [ABSTRACT FROM AUTHOR]

Background: Post-bariatric surgery hypoglycemia has been previously reported. However, its prevalence remains uncertain due to variability of diagnostic criteria, types of bariatric procedures and possible lack of awareness. Objective: To determine the frequency and severity of symptomatic and asymptomatic hypoglycemia in persons following 3 different surgical procedures ≥ 1 years before evaluation, and a group of non-operated obese persons. Design and Setting: Observational cohort study conducted at an out-patient clinic. Fifty-one consecutive individuals were enrolled: post Roux-en-Y gastric bypass (RYGB) (n=16), post omega loop gastric bypass (OLGB) (n=12), post sleeve gastrectomy (SG) (n=15), obese persons prior to surgery (controls) (n=8). Hypoglycemic events (blood glucose ≤ 54 mg/dL) and severe hypoglycemia (blood glucose ≤ 40 mg/dL) were evaluated by: symptoms' questionnaire, mixed meal tolerance test (MMT) and continuous glucose monitoring (CGM). Results: According to questionnaires, meal-related complaints were reported in 11 (26%) of the surgical group and 1/8 of controls. During MMT, 88%, 82% and 67% experienced hypoglycemia in the RYGB, OLGB and SG groups respectively, vs. none in the controls (P < 0.001). Severe hypoglycemia occurred in 38%, 45% and 7% of the RYGB, OLGB and SG groups respectively, (P= 0.025) but only 10 of the total operated group (24%) reported any symptoms. During CGM, fasting hypoglycemic events occurred more in the RYGB and OLGB vs. the SG group: 55%, 63% vs.17% respectively, (P= 0.036). Conclusions: Post-bariatric surgery hypoglycemia is a very common phenomenon after 3 types of bariatric surgery and can be severe especially following bypass procedures. Intriguingly, our results show that hypoglycemia occurs not only in postprandial but also in fasting state, especially following bypass procedures. In many cases there were no specific complaints that may lead to underestimation of this serious complication. Disclosure: H. Knobler: Advisory Panel; Self; AstraZeneca, Novo Nordisk A/S. L. Lazar: None. S. Sapojnikov: None. G. Pines: None. E. Mavor: None. V. Ostrovsky: None. T. Schiller: Advisory Panel; Self; Novo Nordisk Inc., Sanofi-Aventis. T. Zornitzki: None. [ABSTRACT FROM AUTHOR]

Summary: Total testosterone, which is peripherally converted to its biologically active form dihydrotestosterone (DHT), is the first-line hormone investigation in hyperandrogenic states and infertility in premenopausal women. Polycystic ovary syndrome (PCOS), the most common cause of hyperandrogenism and infertility in young women, is often associated with mild elevations of total testosterone. Whereas very high levels of total testosterone (>2-3 SD of normal reference), are most often associated with hyperandrogenic signs, menstrual irregularity, rapid onset of virilization, and demand a prompt investigation. Herein, we report a case of a 32-year-old woman who was referred to the endocrinology outpatient clinic due to secondary amenorrhea and extremely high testosterone levels without any virilization signs. We initially suspected pitfalls in the testosterone laboratory test. Total serum testosterone decreased after a diethyl-ether extraction procedure was done prior to the immunoassay, but testosterone levels were still elevated. An ovarian steroid-cell tumor (SCT) was then revealed, which was thereby resected. Twenty-four hours post surgery, the total testosterone level returned to normal, and a month later menstruation resumed. This case emphasizes that any discrepancy between laboratory tests and the clinical scenario deserves a rigorous evaluation to minimize misinterpretation and errors in diagnosis and therapeutic approach. Additionally, we describe a possible mechanism of disease: a selective peripheral target-tissue response to high testosterone levels that did not cause virilization but did suppress ovulation and menstruation., Learning Points: Total testosterone is the most clinically relevant hormone in investigating hyperandrogenic states and infertility in premenopausal women. Very high total testosterone levels in women (>2-3 SD of normal reference) are most often associated with hyperandrogenic signs, menstrual irregularities, and a rapid onset of virilization. In women with very elevated testosterone levels and the absence of clinical manifestations, laboratory interference should be suspected, and diethyl ether extraction is a useful technique when other methods fail to detect it. Ovarian steroid cell tumors (SCT) encompass a rare subgroup of sex cord-stromal tumors and usually secrete androgen hormones. SCTs are clinically malignant in 25-43% of cases. A selective response of peripheral target tissues to testosterone levels, with clinical manifestations in some tissues and no expression in others, may reflect differences in the conformation of tumor-produced testosterone molecules.