Management of diabetic neuropathy with memantine: A randomized clinical trial

BACKGROUND

Diabetes patients frequently experience diabetic neuropathy (DN), a microvascular complication that significantly reduces patients' quality of life. Memantine has demonstrated potential benefits for neuropathic pains in preclinical studies. This study aimed to assess the efficacy of memantine in the management of peripheral neuropathy in patients with type 2 diabetes mellitus (T2DM).

METHOD

This randomized clinical trial includes 143 diabetic patients (aged between 18 and 75 years) with a confirmed diagnosis of diabetic neuropathy. Patients were randomly assigned to receive memantine 5 mg twice daily for 1 week, followed by 10 mg twice daily plus gabapentin 300 mg daily (n = 72) or just gabapentin 300 mg daily (n = 71) for 8 weeks. The DN4 questionnaire, monofilament, tuning fork, and Tip-therm tests were used to measure neuropathy at baseline and after the 8-week intervention.

RESULTS

The mean score of the DN4 questionnaire in the memantine group was significantly lower than the control group (p. value: .001). The number of patients with diabetic neuropathy remarkably decreased in the memantine group at the end of the study based on the performed tests (p. value: .001).

CONCLUSION

Memantine functions as a beneficial agent in the management of diabetic neuropathy, which would significantly improve the quality of life in diabetic patients.

Consistency analysis of ultrasound-guided fine-needle aspiration and histopathology results in thyroid nodules

Introduction: Thyroid nodules are considered as a frequent clinical problem. The great majority of thyroid nodules are benign; however malignancy probability is predicted to be 5-10%. The inconsistency between ultrasonography and fine-needle aspiration (FNA) findings is one of important problems in management of thyroid nodules. Objectives: This study was designed to investigate the consistency of ultrasonography, FNA and histopathology findings in thyroid nodules. Patients and Methods: In this descriptive study, 93 patients who were candidate for thyroid surgery were included. Data on ultrasound-guided fine-needle aspiration of the thyroid and histopathologic results before and after surgery were considered. The Cramér’s V and Fisher’s exact tests were conducted for this study. Results: In patients whose ultrasound (US) results were low-suspicious, we observed a significant correlation between FNA and pathology results (Cramér’s V = 0.574, P = 0.037). However, relationship between FNA and pathology was not accessible among patients whose ultrasonography results were intermediate suspicious or high-suspicious due to insufficient number of samples. Conclusion: In our study, a significant correlation was observed between FNA and pathology results in low-suspicious nodules.

Autoimmune thyroid disease in women with ages between 35 to 45 years based on Azar cohort data

Introduction: Autoimmune thyroid diseases are common findings in women of childbearing age that could affect fertility rate, pregnancy outcome and complications after pregnancy. These diseases also correlated with other autoimmune diseases. Objectives: In this study, we aim to evaluate the autoimmune thyroid disease in women aged 35 to 45 years based on Azar cohort study data. Patients and Methods: In this cross-sectional analytical study, 507 women 35-45 years old without previous thyroid disease from Azar cohort study were evaluated. Demographic findings, data related to previous pregnancies, abortion, miscarriage, infertility and gestational diabetes were recorded for all patients. Blood samples were taken from all patients to measure TSH and anti-thyroid peroxidase (anti-TPO) levels. Anti-TPO levels ≥40 IU/mL were considered positive. Results: In the studied women, miscarriage occurred in 5.3%, abortion in 27.6% and infertility in 7.3%. Gestational diabetes was reported in 3.9%. The positive anti-TPO prevalence was 21.5%. Patients with positive anti-TPO compared to those with negative anti-TPO had significantly higher cases of hypothyroidism (P<0.001). There was no difference between patients with and without positive anti-TPO regarding miscarriage (5% versus 6.4%), abortion (27.4% versus 28.4%), infertility (7.5% versus 6.4%) and gestational diabetes (7.9% versus 3.6%) (P>0.05). There was no correlation between age and anti-TPO levels. Conclusion: The prevalence of thyroid antibodies in our study population is higher than previous studies. Anti-TPO positivity has no significant effect on pregnancy outcome in this population. Further studies are necessary to define the exact effect of anti-TPO on pregnancy outcomes.

Comparison of ultrasound findings and fine needle aspiration results between anti-thyroid peroxidase positive and negative patients with nodular goiters

Introduction: Ultrasonography is an optimal approach for thyroid gland evaluation, nodule detection and cancer risk assessment in patients with thyroid nodules. Almost all patients with Hashimoto’s thyroiditis have high levels anti-thyroid peroxidase (anti-TPO) antibodies. Objectives: This study aimed to evaluate the relationship between ultrasonography and fine needle aspiration (FNA) results in anti-TPO antibodies positive and negative patients with nodular goiters. Patients and Methods: This cross-sectional study included 128 patients with nodular goiters, referred to endocrinology clinic of imam Reza hospital, Tabriz, Iran. Anti-TPO levels above and below 16 IU/mL were considered as positive and negative, respectively. All patients underwent thyroid ultrasonography, and eligible nodules were subjected to FNA. Results: Of 128 patients, 33.6% and 66.4% were anti-TPO positive and negative, respectively. FNA was conducted on 196 nodules. A significant relationship was observed between sonographic and FNA results in low and intermediate-suspicion nodules. Chronic lymphocytic thyroiditis (CLT) was more frequently reported in low-suspicion nodules of the anti-TPO positive group (P≤0.0001). In addition, in intermediate-suspicion nodules, CLT was reported in 33.3% of patients in the anti-TPO positive group (P=0.026). No significant difference was observed between other nodules. Conclusion: Based on our findings, when a nodule is classified in low or intermediate-suspicion categories, the possibility of CLT following FNA is significantly higher in the anti-TPO positive group, compared to the anti-TPO negative group.

Real-state of autophagy signaling pathway in neurodegenerative disease; focus on multiple sclerosis

The occurrence of neurodegenerative disease is increasingly raised. From physiopathological aspect, the emergence of auto-reactive antibodies against the nervous system antigens contributes to de-myelination in Multiple sclerosis (MS). These features cause the nervous system dysfunction. The follow-up of molecular alterations could give us a real-state vision about intracellular status during pathological circumstances. In this review, we focus on the autophagic response during MS progression and further understand the relationship between autophagy and MS and its modulatory effect on the MS evolution. The authors reviewed studies published on the autophagy status in neurodegenerative disease and on the autophagy modulation in MS prognosis, diagnosis, and possible therapies. The inevitable role of autophagy was shown in the early-stage progression of MS. Due to critical role of autophagy in different stage of cell activity in nervous system, the distinct role of autophagy should not be neglected in the development, pathogenesis, and treatment of MS.

Effect of probiotic supplements in women with gestational diabetes mellitus on inflammation and oxidative stress biomarkers: a randomized clinical trial

BACKGROUND AND OBJECTIVES

Very little is known about the use of probiotics among pregnant women with gestational diabetes mellitus (GDM) especially its effect on oxidative stress and inflammatory indices. The aim of present study was to measure the effect of a probiotic supplement capsule on inflammation and oxidative stress biomarkers in women with newly-diagnosed GDM.

METHODS AND STUDY DESIGN

64 pregnant women with GDM were enrolled in a double-blind placebo controlled randomized clinical trial in the spring and summer of 2014. They were randomly assigned to receive either a probiotic containing four bacterial strains of Lactobacillus acidophilus LA-5, Bifidobacterium BB-12, Streptococcus Thermophilus STY-31 and Lactobacillus delbrueckii bulgaricus LBY-27 or placebo capsule for 8 consecutive weeks. Blood samples were taken pre- and post-treatment and serum indices of inflammation and oxidative stress were assayed. The measured mean response scales were then analyzed using mixed effects model. All statistical analysis was performed using Statistical Package for Social Sciences (SPSS) software (version 16).

RESULTS

Serum high-sensitivity C-reactive protein and tumor necrosis factor-α levels improved in the probiotic group to a statistically significant level over the placebo group. Serum interleukin-6 levels decreased in both groups after intervention; however, neither within group nor between group differences interleukin-6 serum levels was statistically significant. Malondialdehyde, glutathione reductase and erythrocyte glutathione peroxidase levels improved significantly with the use of probiotics when compared with the placebo.

CONCLUSIONS

The probiotic supplement containing L.acidophilus LA- 5, Bifidobacterium BB- 12, S.thermophilus STY-31 and L.delbrueckii bulgaricus LBY-2 appears to improve several inflammation and oxidative stress biomarkers in women with GDM.

What does the research say about androgen use and cerebrovascular events?

Many studies have investigated the benefits of androgen therapy and neurosteroids in aging men, while concerns remain about the potential associations of exogenous steroids and incidents of cerebrovascular events and ischemic stroke (IS). Testosterone is neuroprotective, neurotrophic and a potent stimulator of neuroplasticity. These benefits are mediated primarily through conversion of a small amount of testosterone to estradiol by the catalytic activity of estrogen synthetase (aromatase cytochrome P450 enzyme). New studies suggest that abnormal serum levels of the nonaromatized potent metabolite of testosterone, either high or low dihydrotestosterone (DHT), is a risk factor for stroke. Associations between pharmacologic androgen use and the incidence of IS are questionable, because a significant portion of testosterone is converted to DHT. There is also insufficient evidence to reject a causal relationship between the pro-testosterone adrenal androgens and incidence of IS. Moreover, vascular intima-media thickness, which is a predictor of stroke and myocardial symptoms, has correlations with sex hormones. Current diagnostic and treatment criteria for androgen therapy for cerebrovascular complications are unclear. Confounding variables, including genetic and metabolic alterations of the key enzymes of steroidogenesis, ought to be considered. Information extracted from pharmacogenetic testing may aid in expounding the protective-destructive properties of neurosteroids, as well as the prognosis of androgen therapy, in particular their cerebrovascular outcomes. This investigative review article addresses relevant findings of the clinical and experimental investigations of androgen therapy, emphasizes the significance of genetic testing of androgen responsiveness towards individualized therapy in post-IS injuries as well as identifying pertinent questions.

Chronic Exposure of Human Endothelial Progenitor Cells to Diabetic Condition Abolished the Regulated Kinetics Activity of Exosomes

By virtue of lifestyle change, incidence of diabetes mellitus type 2 is increasingly being raised with different up-surging pathologies. It was showed that endothelial progenitor cells (EPCs) were disqualified in neo-angiogenesis induction. Besides, to an aborted differentiation property, malfunctioned paracrine activities worsen off vascular abnormality. Nano-scaled exosomes play essential roles in reciprocal cell-cell crosstalk via bioactive molecules. To address the effect of diabetic serum on exosome secretion capacity, EPCs were exposed to diabetic condition for seven days. In addition to in-vitro tubulogenesis, migration and LDL uptake assessment, exosome release capacity, and expression profiles of three genes participating in exosome kinetics, including CD63, Alix and Rab27a, revealed by Real-time PCR method. Data showed diabetic sera not only abolished the in-vitro tubulogenesis, migration and LDL uptake properties but also decreased exosome release and expression of related genes. This study sheds lights on the adverse effect of diabetic condition on exosome kinetics in EPCs.

The effect of pioglitazone on weight, lipid profile and liver enzymes in type 2 diabetic patients

BACKGROUND

Pioglitazone is one of the antidiabetic agents used in the management of type 2 diabetes mellitus (DM). The effect of pioglitazone on blood glucose, lipid profile, liver enzymes and weight has been shown with conflicting results. In this study we aim to evaluate the effect of pioglitazone on the weight, lipid profile and liver enzymes in patients with DM.

METHODS

In this single-arm clinical trial, 110 poorly controlled diabetic type 2 patients (63.6% female with mean age of 54.26 ± 8.96 years) who were on maximal dosage of metformin and glibenclamide were enrolled. Patients were treated with pioglitazone for 3 months and laboratory. Fasting blood sugar (FBS), haemoglobin A1C (HbA1C), cholesterol, triglyceride, low-density lipoprotein (LDL) and high-density lipoprotein (HDL), alkaline phosphatase (ALK-P), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and weight changes were measured before and at the end of the study.

RESULTS

The levels of FBS (p < 0.001), HbA1c (p < 0.001), triglyceride (p = 0.001), ALT (p = 0.005) and ALK-P (p = 0.001) were significantly decreased, but weight was significantly increased (p < 0.001) after the intervention. There were no significant difference in cholesterol, LDL and HDL values before and after study.

CONCLUSION

Although pioglitazone causes a significant decrease in FBS, HbA1C and triglyceride levels, it is associated with weight gain, which would limit its utility. IRCT registration code: IRCT201209276712N2.

Subclinical hypothyroidism effects on cardiac function

To evaluate heart function in subclinical hypothyroid women in comparison with healthy subjects, a prospective study was performed on newly detected subclinical hypothyroid women presenting to endocrinology clinic of Tabriz Sina Hospital from October 2007 to February 2008. Thirty five women with Subclinical Hypothyroidism (SH) in case group were matched with 35 healthy euthyroid women in control group. All patients in both groups were studied by two dimensional echocardiography and Tissue Doppler Imaging (TDI) in Tabriz Shahid Madani Hospital. The FT4 and TSH levels were measured. Comparison of TDI results in Right Ventricle (RV) showed the significantly lower mean T(v) excursion in case group with no significant difference in other parameters. In Left Ventricle (LV), the mean A(m), A(v) and E(v)/E(m) were significantly higher and E/A was lower in the case group, but there was no significant difference in other parameters. No RV diastolic dysfunction was documented in both groups. There was no case with LV systolic dysfunction in both groups. There were 21 (60%) patients with LV diastolic dysfunction in the case group comparing with 11 (31.4%) cases in the control group (p = 0.016, OR = 0.306). Frequency of LV diastolic dysfunction was significantly higher in the case group in patients aged > or = 40 years (94.1% vs. 53.3%; p = 0.013). There was no case of pericardial effusion in the studied population. According to our results, SH may cause LV diastolic dysfunction. Likewise, minor RV systolic dysfunction might be seen in these patients.