Kaposi's sarcoma after long-acting steroids: time until remission and drug washout.

Long-acting steroids (LAS) are widely used to treat various inflammatory diseases and allergies. They have many adverse effects including the inhibition of the hypothalamopituitary axis that can last several months. LAS are also strong immunosuppressors and can result in severe opportunistic infections and immunodeficiency-related malignancies. However, the time needed for immune recovery after withdrawal of LAS is unknown. Here we report a case of Kaposi's sarcoma (KS) and severe immunosuppression after a chronic triamcinolone acetonide (TA) treatment. Six months after withdrawal, traces of TA were still detected in the serum by HPLC mass spectrometry. At 8 months, the drug became undetectable, and clinical and biological signs of immune recovery - beginning of KS regression, normalization of IgG levels and CD4 T lymphocyte counts - became noticeable. We then provide a review of the literature on the time until remission of KS after immunosuppression reduction. We also reviewed the cases of KS induced by TA, and the metabolic side effects of TA when compared to standard glucocorticoids.

Family history of diabetes impacts on interactions between minimal model estimates of insulin sensitivity and glucose effectiveness.

AIMS/HYPOTHESIS: Insulin resistance and glucose effectiveness (S(G)) are major determinants of glucose tolerance and independently predict the development of type 2 diabetes in individuals with a family history of disease. We examined the inter-relationship between insulin sensitivity (S(I)) and S(G) in offspring of two parents with type 2 diabetes and in individuals with no family history of diabetes. METHODS: Fifty non-diabetic individuals, including 26 offspring of two type 2 diabetic parents (family history, FH+) and 24 with no family history of diabetes (FH-) similar in gender, age, ethnicity and body mass index (BMI) were studied. Each subject underwent a 100-g oral glucose tolerance test (OGTT) and insulin modified frequently sampled intravenous glucose tolerance, analysed using the Bergman's minimal model (MINMOD). RESULTS: Thirteen subjects of the FH+ group and nine of the FH- group had impaired glucose tolerance (IGT). S(I) and S(G) were independent variables in the FH+ group, while they correlated highly with each other in the FH- group (r = 0.69, p = 0.0002). The relationship between S(I) and S(G) persisted when analysing the IGT and normal glucose tolerance subgroups separately, demonstrating that these associations were not because of differences in glycaemia. Consistently, S(G) strongly correlated with additional measures of insulin resistance only in the FH- group, including fasting insulin (r = 0.56, p = 0.004), homeostasis model assessment of insulin resistance (r = 0.57 p = 0.003) and BMI (r = 0.66, p = 0.0004). CONCLUSIONS: These results demonstrate that familial factors impart important physiological differences in the inter-relationship between insulin-dependent and insulin-independent glucose disposal, which may be important in modulating risk for development of disease.

[Postural study on healthy subjects during experimental vocal effort]. / Etude posturale de sujets normaux en situation expérimentale d'effort vocal.

INTRODUCTION: The objective of the study was to assess how posture and vocal acoustics are modified when one needs to communicate despite environmental obstacles (i.e. vocal effort performance). METHOD: 20 healthy young women participated to this study. They had to communicate numbers to a listener. Environmental obstacles were the distance between the subject and the auditor, and the noise. Segmental posture modifications were recorded and analyzed using the numerical infra-red system for movement analysis SMART. Vocal acoustics and electroglottography were also recorded and analyzed using the EVA system. RESULTS: The study showed the presence of objective postural modifications during vocal effort. Their amplitude increased when the environmental obstacles to communications increased, and they anticipated the vocal production. DISCUSSION: The vocal effort concept and its relation with the posture, the voice and the subject's feeling are reviewed on the basis of these results. Laryngeal effort is not isolated, but belongs to a global behavioral strategy which aims to improving the efficiency of the communication.

High-sensitivity C-reactive protein does not improve the differential diagnosis of HNF1A-MODY and familial young-onset type 2 diabetes: A grey zone analysis.

AIM: Low plasma levels of high-sensitivity C-reactive protein (hs-CRP) have been suggested to differentiate hepatocyte nuclear factor 1 alpha-maturity-onset diabetes of the young (HNF1A-MODY) from type 2 diabetes (T2D). Yet, differential diagnosis of HNF1A-MODY and familial young-onset type 2 diabetes (F-YT2D) remains a difficult challenge. Thus, this study assessed the added value of hs-CRP to distinguish between the two conditions. METHODS: This prospective multicentre study included 143 HNF1A-MODY patients, 310 patients with a clinical history suggestive of HNF1A-MODY, but not confirmed genetically (F-YT2D), and 215 patients with T2D. The ability of models, including clinical characteristics and hs-CRP to predict HNF1A-MODY was analyzed, using the area of the receiver operating characteristic (AUROC) curve, and a grey zone approach was used to evaluate these models in clinical practice. RESULTS: Median hs-CRP values were lower in HNF1A-MODY (0.25mg/L) than in F-YT2D (1.14mg/L) and T2D (1.70mg/L) patients. Clinical parameters were sufficient to differentiate HNF1A-MODY from classical T2D (AUROC: 0.99). AUROC analyses to distinguish HNF1A-MODY from F-YT2D were 0.82 for clinical features and 0.87 after including hs-CRP. For the grey zone analysis, the lower boundary was set to miss<1.5% of true positives in non-tested subjects, while the upper boundary was set to perform 50% of genetic tests in individuals with no HNF1A mutation. On comparing HNF1A-MODY with F-YT2D, 65% of patients were classified in between these categories - in the zone of diagnostic uncertainty - even after adding hs-CRP to clinical parameters. CONCLUSION: hs-CRP does not improve the differential diagnosis of HNF1A-MODY and F-YT2D.

Prevention of type 2 diabetes: are we ready?

Type 2 diabetes is the most common metabolic disease. The cost of diabetes to the individual and to society, and the pandemic prevalence makes disease prevention of extreme importance. Persons with impaired glucose tolerance, modest elevations in blood glucose that remain below levels diagnostic for diabetes, are at increased risk of progression to overt diabetes. New studies evaluate the role of lifestyle interventions including diet and exercise, and the potential role of multiple classes of pharmaceutical agents including the insulin sensitizers, biguanides and thiazolidendiones, and carbohydrase and lipase inhibitors in disease prevention of such high-risk individuals. Many of these strategies appear to be effective to delay, and perhaps prevent, the development of type 2 diabetes and thus should be considered for broader clinical application. Awareness of the extent of the problem and the potential benefits of prevention needs to be raised in both physicians and in the at high risk population.

[Pathogenesis of uro-gynecologic disorders in post-menopausal women]. / Patogenesi dei disturbi uro-ginecologici della post-menopausa.

In the pathogenesis of uro-gynaecological complaints in post-menopausal women, the effects of aging and estrogenic deprivation operate jointly to produce complex clinical conditions where numerous different factors are involved: neurological disorders, loss of the usual support of the pelvic organs, rigid urethral wall, atrophy of urethrovesical and genital epithelium. The Authors analyse all these factors and dwell upon mechanisms by which they lead to the various genito-urinary affections of the female climacteric.

[Administration of uterotonic drugs at the end of the expulsion stage. Comparison of the use of oxytocin and ergometrine maleate]. / La somministrazione di farmaci uterotonici alla fine del periodo espulsivo. Confronto fra l'uso di ossitocina e quello di ergometrina maleato.

In spite of the large diffusion of uterotonic drugs some doubts persist about which preparation and which dosage are the most suitable. For such a reason a group of pregnant women, to whom ergometrine maleate was administered at the delivery of the anterior shoulder of the fetus, was compared by the authors to an analogous group formed by pregnant women to whom oxytocin was administered under the same conditions. Pregnant women not submitted to a pharmacologic control of the third stage of labour served as a control group. Each study group was thereafter divided into 2 subgroups: the former is composed by patients submitted to episiotomy and the latter by patients not submitted to this procedure. Our results have shown the usefulness of both drugs in the active management of the third stage of labour, whereas different side effects may occur.

[Postpartum perineal evaluation. Role of the Q-tip test]. / Valutazione perineale post-partum. Il ruolo del Q-tip test.

Data reported in this study concern 56 women who were subjected, 1 and 6 months after delivery, to a perineal examination including, in addition to the functional evaluation of the levator ani muscles, the "Q-tip test". A positive Q-tip test is associated with a greater incidence of stress urinary incontinence, especially when, at the same time, the score for the functional evaluation of the levator ani muscles ("Perineal Testing") is inferior to 3. The results of this study seem to indicate a greater gravity and ventral extension of obstetric perineal injuries.

[Fetal bradycardia during the second stage of labor. Study of 72 cases]. / Bradicardia fetale durante il secondo stadio del travaglio. Studio condotto su 72 casi.

The Authors analyse cardiotocographic patterns characterized by a constant frequency level below 120 beats/minute during the second stage of labour. Some aspects of "terminal bradycardia" (length, amplitude of oscillations, fetal heart rate in the 30 minutes preceding the onset of bradycardia) are related with the condition of the newborn (1st and 5th minute Apgar-score). Terminal bradycardia (Fischer 3, Melchior 2, 3 and 4, 2nd and 4th of Thiery) seems to have an unfavourable prognostic value especially when prolonged (more than 20 minutes), associated with low base-line variability and when cardiotocographic pattern previous to the fall of frequency is characterized by variable and late decelerations.

[Monitoring of protracted pregnancy. Comparison of two methods]. / Monitoraggio della gravidanza protratta. Due metodiche a confronto.

Antepartum cardiotocographic patterns (NsT:Nonstress Test) and echographic assessments of amniotic fluid pockets were retrospectively analysed in 63 postdate pregnancies. The results of NsT (Fisher-score) and ecographic examinations were correlated with obstetric outcome (5 minutes Apgar-score). Ecographic assessments of amniotic volumes seem more effective than NsT for the lower frequency of false-positive results. Anyhow, considering the low sensibility of NsT and Echography separatedly considered, the Authors suggest a simultaneous valuation of the two tests.

[Functional evaluation of the perineum in pregnancy. Hypertonia of the levator ani muscles]. / Valutazione funzionale del perineo in gravidanza. L'ipertonia dei muscoli elevatori dell'ano.

In this study, the role of "levator ani muscles hypertonia" among pathogenetic factors of perineal obstetric injuries is analysed. For this purpose, clinical data of 142 pregnant women, who underwent functional evaluation of perineum during pregnancy and 30 days after delivery were examined. Data here reported are not sufficient to confirm the importance of this factor within the pathogenesis of postpartum perineal deficiency. Levator ani hypertonia on one hand seems to be able to obstruct fetal progression, on the other hand it presumably constitutes, as an expression of a good voluntary control of perineal muscles, a favourable prognostic factor.

[Functional evaluation of the perineum in pregnancy. Inversion of control]. / Valutazione funzionale del perineo in gravidanza. L'inversione del comando.

This study concerns clinical data of 142 women, who were subjected to functional evaluation of perineum during the last part of pregnancy. The 16 cases characterized by synergic activation, during the examination of perineal muscles ("perineal testing"), of antagonist muscles ("inverted control"), were examined taking into account data regarding evolution of labour and perineal outcome. "Inverted control" seems to influence, in this study, length of the second stage and frequency of operative deliveries whereas we can't confirm the importance of this disorder within pathogenesis of perineal obstetric complications.

[Oligoamnios in protracted pregnancy. Cardiotocographic aspects]. / L'oligoamnios nella gravidanza oltre il termine. Aspetti del cardiotocogramma.

Ecographic assessments of amniotic fluid volumes and their relationship to ante-partum cardiotocographic patterns were retrospectively analyzed in 59 postdate pregnancies. Sonographic evidence of oligoamnios is significantly related with absence of sporadic accelerations and rarity of fetal movements.

[Static anomalies of the pelvis caused by labor. Maternal weight increase during pregnancy as a risk factor]. / Le anomalie della statica pelvica conseguenti al parto. L'incremento ponderale gravidico materno quale fattore di rischio.

In this retrospective study, the role of Gravidic Maternal Ponderal Increase (GMPI) within pathogenetic factors of perineal obstetric injuries, is analysed. TO this purpose, clinical data of 58 puerperae, who underwent a functional evaluation of perineum 30 days after delivery, were examined. The results of this study seem to indicate an autonomous pathogenetic role of GMPI, besides the indirect relation deriving from the association with other risk factors (age, parity, diabetes, fetal megalosomia, ecc).

Influence of migration on characteristics of type 2 diabetes in sub-Saharan Africans.

AIM: This study compared the clinical and biochemical characteristics and microvascular complications found in three groups of type 2 diabetes (T2D) patients: Africans living in Africa; African immigrants living in France; and Caucasians living in France. METHODS: Diagnosed T2D Africans living in Cameroon (n=100) were compared with 98 African migrants diagnosed with T2D after having moved to France, and a group of 199 T2D Caucasian patients living in France. All underwent clinical and biochemical evaluations, and all were assessed for microvascular complications. RESULTS: The median duration of stay of the migrants in France was 15years before being diagnosed with diabetes. Despite similar durations of diagnosis, they were 8.9years younger at the time of diagnosis than Africans living in Cameroon (P<0.001). Caucasians and African immigrants in France had lower HbA1c values than Africans in Cameroon (P<0.001); they were also more aggressively treated for hypertension and dyslipidaemia and, therefore, had significantly lower blood pressure levels and better lipid profiles. Diabetic nephropathy and retinopathy rates were higher in Cameroon than in the two other groups. After adjusting for age, diabetes duration, HbA1c, hypertension and other covariates, only the prevalence of diabetic nephropathy (OR: 5.61, 95% CI: 2.32-13.53; P<0.0001) was higher in Cameroon compared with those living in France. CONCLUSION: Our results suggest that Africans who emigrate to France may develop diabetes earlier than those staying in their home country. However, the latter may be a reflection of late diagnosis of diabetes. Also, the less adequate diabetes and hypertension control in the latter would explain their higher rates of nephropathy. Large-scale cohorts are now warranted to substantiate these observations.

Management of pregnancy in women with type 1 diabetes mellitus: guidelines of the French-Speaking Diabetes Society (Société francophone du diabète [SFD]).

AIM: The clinical guidelines reported by the French-Speaking Diabetes Society (Société francophone du diabète) include updated recommendations for preconceptual planning and care in the management of pregnancy in women with type 1 diabetes mellitus (T1DM). METHODS: The working group included diabetologists, as well as an obstetrician, a nurse and a dietician. A review of the literature was performed using PubMed and Cochrane databases. Guidelines published by foreign diabetes societies were also consulted. RESULTS: In women with T1DM, pregnancy increased the risks of hypoglycaemia, diabetic ketoacidosis, pregnancy-induced hypertension, infections and worsening of diabetic microvascular disease. Moreover, T1DM during pregnancy had an impact on the embryo and the fetus, and may have increased the risk of spontaneous miscarriages, malformations, premature births, and fetal and neonatal complications. However, intensive glycaemic control and preconceptual care have been shown to decrease the rate of fetal demise and malformations. Also, the use of insulin analogues during pregnancy is now regarded as safe. Tight glucose control and frequent follow-up are recommended throughout pregnancy in women with T1DM. Their obstetric management should take place in a maternity hospital with an appropriate perinatal environment and in close collaboration with diabetologists. CONCLUSION: Pregnancy planning and adequate management during pregnancy are mandatory for improving the outcomes of women with T1DM.