A rare case of hemichorea in the setting of non-ketotic hyperglycaemia with subtle radiological changes: a case report

Movement disorders have been associated with hyperglycaemia including chorea, hemiballismus and choreoathetosis. In almost all documented cases, there is an association between clinical and radiological findings. We report a case of an 82-year-old man with hemichorea in the setting of hyperglycaemia and poorly controlled type 2 diabetes. He had subtle striatal changes on his radiology, and with intravenous fluids and insulin, his involuntary movements resolved on day 4, which correlated with improvement in glycaemic control. He was followed up through our local insulin stabilization programme after discharge.

Short-term glucose variability in healthy volunteers is not associated with raised oxidative stress markers

It is unknown whether glycaemic variability adds to the risk of microvascular complications of diabetes over and above the mean glucose value for a patient. We examined the effect of purposefully induced short-term glycaemic variability on oxidative stress markers. Eleven healthy subjects underwent three sequential glycaemic states; sustained hyperglycaemia, sustained euglycaemia and variable glycaemia, using glycaemic clamps for 3 h. Twenty-four hours urinary 8-isoprostane-PGF2α was measured before and after each glycaemic state to assess oxidative stress. The median and interquartile range of the urinary 8-iso-PGF2α in ng/24 h were (1373, 513), (996, 298) and (1227, 472) for the euglycaemic, hyperglycaemic and variable states, respectively. There was no significant difference in urinary isoprostanes between the three different states; mean ranks 20.9, 11.9 and 18.2 for the euglycaemic state, hyperglycaemic state and glycaemic variability state, respectively, p = 0.083. In conclusion, we did not see a significant increase in the urinary isoprostanes when glycaemic variability was induced under controlled conditions in healthy individuals.

Efficacy and safety of ultra-long-acting insulin degludec

All patients with type 1 diabetes and significant numbers of those with type 2 diabetes are treated with insulin. Nonadherence to insulin regimen can impact glycaemic control. Insulin degludec is a new generation, ultra-long-acting basal insulin that forms soluble multihexamers at the injection site that slowly release insulin degludec monomers into the circulation giving a prolonged duration of action. Insulin degludec may provide a safe and convenient dosing option for patients who require some flexibility in adhering to an insulin regimen according to their lifestyle or circumstances. In this review we focus on the early phases of insulin degludec development.

Insulin degludec--a new-generation basal insulin

Insulin degludec may provide dosing options for patients who, because of their lifestyle, require some flexibility in adhering to an insulin regimen, and it may also reduce the risk of hypoglycemia compared with the basal insulins that are currently available.

A comparison of methods for the measurement of 8-isoPGF(2α): a marker of oxidative stress

BACKGROUND

Oxidative stress describes the cellular damage caused by excess reactive oxygen species not adequately inactivated by antioxidants. Oxidative stress has been implicated in playing a role in many disorders. Lipid peroxidation end-products are employed as markers of oxidative stress, of which the isoprostane, 8-iso-PGF(2α), is widely used. 8-iso-PGF(2α) is measured in plasma or urine by gas chromatography-mass spectrometry (GC/MS), liquid chromatography-mass spectrometry (LC/MS), tandem-mass spectrometry or enzyme-linked immunosorbent assay (ELISA). However, discrepancies between the specificity of these methods means correlation is poor.

METHODS

A tandem-mass spectrometric (LC/MS/MS) method, using immunoaffinity purification, for urinary 8-iso-PGF(2α) was developed and compared with two commercial ELISAs (A--Cayman Chemicals, B--Oxford Biomedical Research) in urine samples (n = 156).

RESULTS

An LC/MS/MS method coupled to immunoaffinity purification was developed with satisfactory performance and comparison to ELISAs A and B. Spearman rank correlation demonstrated significant correlation between all methods (P = <0.0001); however, r² values ranged from 0.68 to 0.72. Bland-Altman plots revealed a proportional positive bias of ELISA B when compared with ELISA A and LC/MS/MS. Furthermore, the agreement between ELISA A and LC/MS/MS was poor.

CONCLUSIONS

The poor agreement between methods for measurement of 8-iso-PGF(2α) highlights differences in selectivity. 8-iso-PGF(2α) is an isoprostane, a family of isomeric end-products of arachidonic acid peroxidation, which are produced by peroxidation or enzymatically. This makes avoiding cross-reactivity between 8-iso-PGF(2α) and related isomers challenging. When assessing oxidative stress studies, the selectivity of the methods used should be taken into account, particularly when comparing studies.

The bioavailability of eicosapentaenoic acid from reconstituted triglyceride fish oil is higher than that obtained from the triglyceride and monoglyceride forms

Omega 3 fatty acids have healthcare benefits, but their absorption characteristics are not well defined, particularly for strategies to improve their bioavailability. We performed a double blind study comparing the bioavailability of 20% eicosapentaenoic acid in 4.5 grams of: natural triglyceride, reconstituted triglyceride, enzymatically synthesized triglyceride, monoglyceride and diglyceride. Seven healthy volunteers were given the supplements on five occasions while repeated measurements of eicosapentaenoic acid were taken to calculate the area under the curve for the next 24 hours. There was a significant difference between the mean of calculated area under the curve of eicosapentaenoic acid from reconstituted triglyceride (30.2) and that of the enzymatically synthesized triglyceride (11.9) and monoglyceride (13.4), z=-2.36 and -2.19, respectively, p<0.05. In summary, eicosapentaenoic acid bioavailability of chemically reconstituted triglycerides was better than that obtained from enzymatically synthesized triglyceride and monoglyceride.

Low dose cabergoline for hyperprolactinaemia is not associated with clinically significant valvular heart disease

OBJECTIVE

Recent trials suggest that using ergot-derived dopamine agonists such as cabergoline in the treatment of Parkinson's disease is associated with an increased risk of valvular heart disease. However, the dose of cabergoline used to treat hyperprolactinaemia is considerably less than that used in Parkinson's disease.

DESIGN AND METHODS

A cross-sectional comparative assessment. Forty-four patients treated with cabergoline for hyperprolactinaemia underwent transthoracic echocardiography and were compared with 566 sequential subjects complaining of palpitations, taken from a contemporary echocardiography database.

RESULTS

The mean cumulative dose of cabergoline in the cases was 311 mg. There was no significant, severe or moderate, right- or left-sided valvular regurgitation in either group. Left heart: in the mitral and aortic valves, the rate of mild and trivial valvular regurgitation was not different between the two groups. Right heart: mild tricuspid and pulmonary regurgitation on colour Doppler alone was increased significantly in the cabergoline group, odds ratios of 3.1 and 7.8 respectively (95% confidence interval 1.0-9.6 and 0.8-78.4, P=0.04 and P<0.0001 respectively).

CONCLUSION

Cabergoline at doses sufficient to suppress hyperprolactinaemia for a period of 3-4 years is not associated with an increased risk of clinically significant valvular regurgitation.

Common psychiatric disorders over a lifetime: age of onset, risk and treatment contact in the Nigerian survey of mental health and wellbeing

The study is to estimate prevalence, risk, and contact with services of mental health problems in the Nigerian community. Face-to-face interviews with a representative sample of persons aged 18 years and over (n = 6752) using the World Health Organization's Composite International Diagnostic Interview, Version 3. Lifetime DSM-IV prevalence estimates were 6.5% for anxiety disorders, 3.3% for mood disorders, 3.7% for substance use disorders, and 12.0% for any disorder. The median age of onset (represented by the 50th percentile age of onset) is 25 years for any disorder but ranged from 11 years for anxiety disorder to 42 years for mood disorder. The projected lifetime risks at age 75 years were considerably higher than prevalence estimates. For mood disorders, lifetime risk was 170% higher than the prevalence estimate. Ascertainment bottlenecks seem to account for some low prevalence estimates. In general, only a minority of persons with mental disorders made any treatment contact. The median delay in duration before seeking care ranged between 6 years for mood disorders and 16 years for anxiety disorders. Projected lifetime risks of mood disorders and possible false negatives for some disorders suggest that the societal burden of mental disorders is considerably higher than the prevalence estimates indicate. Nevertheless, even for identified cases, current treatment coverage falls far short of need.

Secondary amenorrhoea due to pheochromocytoma: a case report

Introduction

Pheochromocytoma is a chromaffin cell catecholamine-secreting tumour originating from the adrenal medulla.

Case presentation

We report here an unusual presentation of pheochromocytoma with secondary amenorrhoea and its resolution after medical treatment with the alpha adrenergic blocker, Phenoxybenzamine.

Conclusion

Pheochromocytoma is a rare cause of secondary amenorrhoea.