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Younes YR, Cron N, Field BC, Nayyar V, Clark J, Zachariah S, Lakshmipathy K, Isuga JO, Maghsoodi N, Emmanuel J. Proposed treatment strategy for reactive hypoglycaemia. Front Endocrinol (Lausanne) 2024; 15:1332702. [PMID: 38370356 PMCID: PMC10869498 DOI: 10.3389/fendo.2024.1332702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/15/2024] [Indexed: 02/20/2024] Open
Abstract
Background/aim Managing reactive hypoglycaemia (RH) poses challenges due to limited and often ineffective treatment options. We report a case series and draw on this to propose a stepwise treatment approach consisting of lifestyle modifications, metformin, GLP-1 analogues, and the use of flash glucose monitoring technology. Method A retrospective review was conducted to analyse the management of 11 cases presenting with recurrent RH symptoms. Result Two patients experienced successful resolution of symptoms through lifestyle modifications. Metformin alone was effective in treating seven out of nine patients who received pharmacological treatment. Two patients with previous upper gastrointestinal surgery showed a partial response to metformin and benefited further from additional long-acting GLP-1 analogue. Pharmacological intervention led to significant reductions in insulin and C-peptide levels in repeat mixed meal tolerance tests (P-values 0.043 for insulin and 0.006 for C-peptide). Finally, flash glucose monitoring technology was useful in early detection and preventing episodes of hypoglycaemia in one of these patients with persistent symptoms. Conclusion These findings highlight the potential efficacy of escalated treatment strategies for RH, including the use of metformin, GLP-1 analogues, and flash glucose monitoring technology.
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Affiliation(s)
- Younes R. Younes
- Department of Diabetes & Endocrinology, East Surrey Hospital, Surrey & Sussex Healthcare NHS Trust, Redhill, United Kingdom
| | - Nicholas Cron
- Department of Statistics, London School of Economics, London, United Kingdom
| | - Benjamin C.T. Field
- Department of Diabetes & Endocrinology, East Surrey Hospital, Surrey & Sussex Healthcare NHS Trust, Redhill, United Kingdom
- Section of Clinical Medicine, Faculty of Health & Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Vidhu Nayyar
- Department of Diabetes & Endocrinology, East Surrey Hospital, Surrey & Sussex Healthcare NHS Trust, Redhill, United Kingdom
| | - James Clark
- Department of Diabetes & Endocrinology, East Surrey Hospital, Surrey & Sussex Healthcare NHS Trust, Redhill, United Kingdom
| | - Sunil Zachariah
- Department of Diabetes & Endocrinology, East Surrey Hospital, Surrey & Sussex Healthcare NHS Trust, Redhill, United Kingdom
| | - Kavitha Lakshmipathy
- Department of Diabetes & Endocrinology, East Surrey Hospital, Surrey & Sussex Healthcare NHS Trust, Redhill, United Kingdom
| | - Jimboy O. Isuga
- Department of Diabetes & Endocrinology, East Surrey Hospital, Surrey & Sussex Healthcare NHS Trust, Redhill, United Kingdom
| | - Negar Maghsoodi
- Chemical Pathology Department, University Hospitals Sussex NHS Foundation Trust, Royal Sussex County Hospital, Brighton, United Kingdom
| | - Julian Emmanuel
- Department of Diabetes & Endocrinology, East Surrey Hospital, Surrey & Sussex Healthcare NHS Trust, Redhill, United Kingdom
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Maghsoodi N, Streetly M, Crook M. Dyslipidaemia and metabolic syndrome in multiple myeloma (MM). Atherosclerosis 2020. [DOI: 10.1016/j.atherosclerosis.2020.10.507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Ragbourne SC, Maghsoodi N, Streetly M, Crook MA. The Association between Metabolic Syndrome and Multiple Myeloma. Acta Haematol 2020; 144:24-33. [PMID: 32408305 DOI: 10.1159/000505992] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 01/11/2020] [Indexed: 12/26/2022]
Abstract
Multiple myeloma (MM) is a haematological malignancy arising from monoclonal proliferation of plasma cells in the bone marrow, resulting in the presence of paraproteins or M-protein in serum. The involvement of paraproteins produced by malignant plasma cells in the development of hyperlipidaemia and low-HDL cholesterol has been described, as has an association with MM and obesity, hypertension, and type 2 diabetes mellitus, and insulin resistance, that is, features of the metabolic syndrome (MS). There is an association between MS components, inflammatory cytokines, and the development of MM, and some drugs used in the treatment of MS such as statins and metformin may improve outcomes in MM.
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Affiliation(s)
- Sophie C Ragbourne
- Department of Chemical Pathology, Guys and St Thomas's Hospital, London, United Kingdom
| | - Negar Maghsoodi
- Department of Chemical Pathology, Guys and St Thomas's Hospital, London, United Kingdom
| | - Matthew Streetly
- Department of Haematology, Guys and St Thomas's Hospital, London, United Kingdom
| | - Martin A Crook
- Department of Chemical Pathology, Guy's and St Thomas' and Lewisham and Greenwich Trust, London, United Kingdom,
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Maghsoodi N, Shaw N, Cross GF, Alaghband-Zadeh J, Wierzbicki AS, Pinkney J, Millward A, Vincent RP. Bile acid metabolism is altered in those with insulin resistance after gestational diabetes mellitus. Clin Biochem 2019; 64:12-17. [DOI: 10.1016/j.clinbiochem.2018.11.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 11/02/2018] [Accepted: 11/29/2018] [Indexed: 12/28/2022]
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Ramachandran R, Alaghband-Zadeh J, Sankaralingam A, Khan SA, Tavabie M, Fernyhough C, Sabry M, Maghsoodi N, McGowan B, Carroll PV, Wierzbicki AS. Suboptimal rise in awakening-induced cortisol is an accurate marker of cortisol insufficiency in patients with normal renal function (eGFR >60 mL/min). Ann Clin Biochem 2017; 55:496-499. [PMID: 28853294 DOI: 10.1177/0004563217732361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The insulin tolerance test is the gold standard for diagnosis of cortisol insufficiency. However, it is cumbersome, invasive, requires supervised hospital facilities and has unpleasant side-effects. A non-invasive outpatient-based test will be useful. We hypothesized that free cortisol concentrations in multiple spot urine samples can be used to diagnose cortisol insufficiency in patients with normal renal function (eGFR > 60 mL/min). Method Patients and controls provided urine samples at bedtime (S1), and first (S2) and second (S3) void the next day. Cortisol and creatinine were measured in all three samples, and cortisol:creatinine ratio (S1, S2 and S3) was used for further analysis. The sum of S1 + S2 + S3 was used to calculate total cortisol secretion (T). Variation (V) in cortisol secretion in response to circadian rhythm was calculated as the modulus of the difference between S1 and S2 and S2 and S3. Results Samples were collected from 96 controls and 11 patients. S1 was significantly lower vs . S2 and S3 in controls ( P < 0.0001) but not in patients. S2, S3, T and V were significantly lower in patients vs . controls ( P < 0.0001). ROC curve analysis using insulin tolerance test as gold standard showed that S2, S3, T and V were all equally accurate diagnostic markers for cortisol insufficiency (AUC: 0.87, NPV: 100%). The best balance of sensitivity and specificity was achieved using T (sensitivity: 100%, specificity: 58%). Conclusion Multiple spot urine samples test is an accurate, relatively inexpensive, non-invasive, convenient outpatient-based screening test for exclusion of cortisol insufficiency.
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Affiliation(s)
- Radha Ramachandran
- 1 King's College London, London, UK.,2 Departments of Endocrinology/Metabolic Medicine/Chemical Pathology, Guy's and St Thomas' Hospitals, NHS Foundation Trust, London, UK
| | | | - Arun Sankaralingam
- 2 Departments of Endocrinology/Metabolic Medicine/Chemical Pathology, Guy's and St Thomas' Hospitals, NHS Foundation Trust, London, UK
| | | | | | | | | | - Negar Maghsoodi
- 1 King's College London, London, UK.,2 Departments of Endocrinology/Metabolic Medicine/Chemical Pathology, Guy's and St Thomas' Hospitals, NHS Foundation Trust, London, UK
| | - Barbara McGowan
- 1 King's College London, London, UK.,2 Departments of Endocrinology/Metabolic Medicine/Chemical Pathology, Guy's and St Thomas' Hospitals, NHS Foundation Trust, London, UK
| | - Paul V Carroll
- 1 King's College London, London, UK.,2 Departments of Endocrinology/Metabolic Medicine/Chemical Pathology, Guy's and St Thomas' Hospitals, NHS Foundation Trust, London, UK
| | - Anthony S Wierzbicki
- 1 King's College London, London, UK.,2 Departments of Endocrinology/Metabolic Medicine/Chemical Pathology, Guy's and St Thomas' Hospitals, NHS Foundation Trust, London, UK
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Maghsoodi N, Crook MA. A case of charcot-marie-Tooth (CMT) disease with hypercholesterolaemia and statin side-effects: A case report and literature review. J Clin Neurosci 2017; 38:57-59. [PMID: 28038830 DOI: 10.1016/j.jocn.2016.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 12/04/2016] [Indexed: 12/30/2022]
Affiliation(s)
- Negar Maghsoodi
- Department of Chemical Pathology, Guy's and St Thomas's Hospital, London, UK
| | - Martin A Crook
- Department of Chemical Pathology, Guy's and St Thomas's Hospital, London, UK; Department of Clinical Biochemistry, Lewisham Hospital NHS Trust, London, UK; University of Greenwich, London, UK.
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Spangenberg A, Maghsoodi N, Dulnoan D, Moore AE, Edwards S, Frost ML, Hampson G. Bone Mineral Density and Body Composition are Associated with Circulating Angiogenic Factors in Post-menopausal Women. Calcif Tissue Int 2016; 99:608-615. [PMID: 27572995 PMCID: PMC5097781 DOI: 10.1007/s00223-016-0186-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 08/06/2016] [Indexed: 12/27/2022]
Abstract
Lean mass (LM) and fat mass (FM) are closely related to bone mass (BM) in post-menopausal women, although their relative importance is unclear. Angiogenic factors which control angiogenesis may influence BM, LM and FM. The aim of the study was to compare the contribution of LM and FM to bone mineral density (BMD) and the association between these tissues and circulating angiogenic factors. The study population comprised of 392 post-menopausal women aged mean [SD] 61.8 [6.4] years. BMD was measured at the lumbar spine (LS), neck of femur and total hip (TH) by dual-energy X-ray absorptiometry (DXA). DXA scan was also used to determine LM and FM. Angiopoietin-1 and 2 (ANG-1, ANG-2) were measured by sandwich enzyme-linked immunosorbent assay. Following adjustment for confounders, significant positive independent associations were seen between LM with BMD at all skeletal sites (TH: p < 0.0001) and FM with BMD at the hip sites (TH: p = 0.004). When BMD and LM were regressed against the angiogenic factors, positive associations were seen between ANG-2 with LM (p = 0.002) and LS BMD (p = 0.05). Negative associations were observed between the ratio of ANG-1/ANG-2 with LS BMD (p = 0.014), TH BMD (p = 0.049) and LM (p = 0.029). FM and fat distribution (android/gynoid fat ratio) were negatively associated with ANG-1 (p = 0.006) and ANG-2 (p = 0.004), respectively. ANG-1 and ANG-2 may be involved in the maintenance of bone, muscle and fat mass.
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Affiliation(s)
- A Spangenberg
- Department of Clinical Chemistry and Metabolic Medicine, St Thomas' Hospital, 5th Floor, North Wing, London, SE1 7EH, UK
| | - N Maghsoodi
- Department of Clinical Chemistry and Metabolic Medicine, St Thomas' Hospital, 5th Floor, North Wing, London, SE1 7EH, UK
| | - D Dulnoan
- Osteoporosis Unit, Guy's Hospital, London, SE1 9RT, UK
| | - A E Moore
- Osteoporosis Unit, Guy's Hospital, London, SE1 9RT, UK
| | - S Edwards
- Osteoporosis Unit, Guy's Hospital, London, SE1 9RT, UK
| | - M L Frost
- Osteoporosis Unit, Guy's Hospital, London, SE1 9RT, UK
| | - G Hampson
- Department of Clinical Chemistry and Metabolic Medicine, St Thomas' Hospital, 5th Floor, North Wing, London, SE1 7EH, UK.
- Metabolic Bone Clinic, Department of Rheumatology, Guy's Hospital, London, SE1 9RT, UK.
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Maghsoodi N, Alaghband-Zadeh J, Cross GF, Werling M, Fändriks L, Docherty NG, Olbers T, Dew T, Sherwood RA, Vincent RP, le Roux CW. Elevated fasting and postprandial C-terminal telopeptide after Roux-en-Y gastric bypass. Ann Clin Biochem 2016; 54:495-500. [DOI: 10.1177/0004563216667964] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background Roux-en-Y gastric bypass increases circulating bile acid concentrations, known mediators of postprandial suppression of markers of bone resorption. Long-term data, however, indicate that Roux-en-Y gastric bypass confers an increased risk of bone loss on recipients. Methods Thirty-six obese individuals, median age 44 (26–64) with median body mass index at baseline of 42.5 (40.4–46) were studied before and 15 months after Roux-en-Y gastric bypass. After an overnight fast, patients received a 400 kcal mixed meal. Blood samples were collected premeal then at 30-min periods for 120 min. Pre and postmeal samples were analysed for total bile acids, parathyroid hormone and C-terminal telopeptide. Results Body weight loss post Roux-en-Y gastric bypass was associated with a median 4.9-fold increase in peak postprandial total bile acid concentration, and a median 2.4-fold increase in cumulative food evoked bile acid response. Median fasting parathyroid hormone, postprandial reduction in parathyroid hormone and total parathyroid hormone release over 120 min remained unchanged after surgery. After surgery, median fasting C-terminal telopeptide increased 2.3-fold, peak postprandial concentrations increased 3.8-fold and total release was increased 1.9-fold. Conclusions Fasting and postprandial total bile acids and C-terminal telopeptide are increased above reference range after Roux-en-Y gastric bypass. These changes occur in spite of improved vitamin D status with supplementation. These results suggest that post-Roux-en-Y gastric bypass increases in total bile acids do not effectively oppose an ongoing resorptive signal operative along the gut–bone axis. Serial measurement of C-terminal telopeptide may be of value as a risk marker for long-term skeletal pathology in patients post Roux-en-Y gastric bypass.
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Affiliation(s)
- Negar Maghsoodi
- Department of Clinical Biochemistry, King’s College Hospital NHS Foundation Trust, London, UK
- Department of Chemical Pathology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | | | - Gemma F Cross
- Department of Clinical Biochemistry, King’s College Hospital NHS Foundation Trust, London, UK
| | - Malin Werling
- Department of Gastrosurgical Research and Education, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Surgery, Sahlgrenska University Hospital/Sahlgrenska, Gothenburg, Sweden
| | - Lars Fändriks
- Department of Gastrosurgical Research and Education, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Surgery, Sahlgrenska University Hospital/Sahlgrenska, Gothenburg, Sweden
| | - Neil G Docherty
- Department of Gastrosurgical Research and Education, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Surgery, Sahlgrenska University Hospital/Sahlgrenska, Gothenburg, Sweden
- Diabetes Complications Research Centre, Conway Institute, University College Dublin, Ireland
| | - Torsten Olbers
- Department of Gastrosurgical Research and Education, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Surgery, Sahlgrenska University Hospital/Sahlgrenska, Gothenburg, Sweden
| | - Tracy Dew
- Department of Clinical Biochemistry, King’s College Hospital NHS Foundation Trust, London, UK
| | - Roy A Sherwood
- Department of Clinical Biochemistry, King’s College Hospital NHS Foundation Trust, London, UK
| | - Royce P Vincent
- Department of Clinical Biochemistry, King’s College Hospital NHS Foundation Trust, London, UK
| | - Carel W le Roux
- Department of Gastrosurgical Research and Education, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Surgery, Sahlgrenska University Hospital/Sahlgrenska, Gothenburg, Sweden
- Diabetes Complications Research Centre, Conway Institute, University College Dublin, Ireland
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Anaraki F, Vafaie M, Behboo R, Esmaeilpour S, Maghsoodi N, Safaee A, Grant M. The city of hope-quality of life-ostomy questionnaire: persian translation and validation. Ann Med Health Sci Res 2014; 4:634-7. [PMID: 25221719 PMCID: PMC4160695 DOI: 10.4103/2141-9248.139355] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Since there is no disease-specific instrument for measuring quality-of-life (QOL) in Ostomy patients in Persian language. Aim: This study was designed to translate and evaluate the validity and reliability of City of Hope-quality of life-Ostomy questionnaire (COH-QOL-Ostomy questionnaire). Subjects and Methods: This study was designed as cross-sectional study. Reliability of the subscales and the summary scores were demonstrated by intra-class correlation coefficients. Pearson's correlations of an item with its own scale and other scales were calculated to evaluated convergent and discriminant validity. Clinical validity was also evaluated by known-group comparisons. Results: Cronbach's alpha coefficient for all subscales was about 0.70 or higher. Results of interscale correlation were satisfactory and each subscale only measured a single and specified trait. All subscales met the standards of convergent and discriminant validity. Known group comparison analysis showed significant differences in social and spiritual well-being. Conclusion: The findings confirmed the reliability and validity of Persian version of COH-QOL-Ostomy questionnaire. The instrument was also well received by the Iranian patients. It can be considered as a valuable instrument to assess the different aspects of health related quality-of-life in Ostomy patients and used in clinical research in the future.
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Affiliation(s)
- F Anaraki
- Department of Surgery, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Vafaie
- Department of Surgery, Iranian Ostomy Society, Tehran, Iran
| | - R Behboo
- Department of Surgery, Division of Colon and Rectal Surgery, Bahman Hospital, Tehran, Iran
| | - S Esmaeilpour
- Department of Surgery, Iranian Ostomy Society, Tehran, Iran
| | - N Maghsoodi
- Gastroenterology and Liver Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - A Safaee
- Department of Prevention and Control of Diseases, Deputy of Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Grant
- Nursing Research and Education City of Hope Medical Center, City of Hope, United States of America
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Affiliation(s)
- Mehdi Mirzazadeh
- Department of Clinical Biochemistry, John Radcliffe Hospital, Oxford, UK
| | - Negar Maghsoodi
- Department of Chemical Pathology, St, Helier Hospital, Carshalton, UK
| | - Jeffrey Barron
- Biochemistry Department, Labtests, Penrose, Auckland, New Zealand
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