COVID-19 Outcomes and Diabetes Mellitus: A Comprehensive Multicenter Prospective Cohort Study.

The link between type 2 diabetes (T2D) and the severe outcomes of COVID-19 has raised concerns about the optimal management of patients with T2D. This study aimed to investigate the clinical characteristics and outcomes of T2D patients hospitalized with COVID-19 and explore the potential associations between chronic T2D treatments and adverse outcomes. This was a multicenter prospective cohort study of T2D patients hospitalized with COVID-19 in Greece during the third wave of the pandemic (February-June 2021). Among the 354 T2D patients included in this study, 63 (18.6%) died during hospitalization, and 16.4% required ICU admission. The use of DPP4 inhibitors for the chronic management of T2D was associated with an increased risk of in-hospital death (adjusted odds ratio (adj. OR) 2.639, 95% confidence interval (CI) 1.148-6.068, p = 0.022), ICU admission (adj. OR = 2.524, 95% CI: 1.217-5.232, p = 0.013), and progression to ARDS (adj. OR = 2.507, 95% CI: 1.278-4.916, p = 0.007). Furthermore, the use of DPP4 inhibitors was significantly associated with an increased risk of thromboembolic events (adjusted OR of 2.249, 95% CI: 1.073-4.713, p = 0.032) during hospitalization. These findings highlight the importance of considering the potential impact of chronic T2D treatment regiments on COVID-19 and the need for further studies to elucidate the underlying mechanisms.

Tissue polypeptide antigen in the follow-up of patients with urinary bladder cancer compared with conventional urine cytology.

The incidence of bladder cancer has demonstrated a rapid increase during the last decades. The aim of this study is to determine the clinical value of serum tissue polypeptide antigen (TPA) as a tumour marker for urinary bladder cancer in comparison with conventional urine cytology. Urine and blood samples were obtained from a total of 108 patients (group A) with a known history of bladder cancer, who presented for their routine 3 month follow-up. These 108 patients included 45 patients with high grade and 63 patients with low grade bladder cancer, and 30 patients with lower urinary tract symptoms (LUTS) and no history of bladder cancer (group B). Urine and blood samples from fifty healthy adults (group C) were also tested; this group served as the control group for estimating the normal range of serum TPA values. In all group A patients cystoscopy and/or bladder biopsies were performed. All blood and urine samples were tested for TPA and conventional urine cytology respectively. Results showed that the upper normal range for TPA was 1.0 ng/mL(0.9 ± 0.04) in the control group. For the subgroups of patients with high and low grade bladder cancer elevated serum TPA levels were found in 52% and 40% of the patients respectively. The overall serum TPA sensitivity and specificity were 50% and 85% respectively for patients with known bladder cancer (group A). We found the sensitivity of cytology for high grade bladder (GIII) carcinomas to be 72%; however when urine cytology was combined with serum TPA the overall sensitivity reached 80%. We conclude that serum TPA combined with urine cytology may be used as a prognostic marker for bladder cancer.

The prognostic value of serum chromogranin A and prostate specific antigen in prostate cancer patients for progression to the hormone resistance state.

Prostate adenocarcinomas (PAC) consist mainly of tumour cells of luminal immunophenotype and scattered neuroendocrine (NE) cells. NE cells are defined by chromogranin A (CgA) immunoreactivity. T he aim of this study is the evaluation of CgA serum levels in monitoring prostate cancer (PC) patients under complete androgen deprivation (CAD) in comparison with the prostate specific antigen (PSA) as a prognostic marker of androgen resistance and bone metastases. Ninety-two patients with newly diagnosed PAC and 30 healthy blood donors serving as the control group were enrolled in the study. Serum CgA and PSA values were measured. All patients had locally advanced or metastatic disease and received CAD treatment. In the group of PAC patients bone scanning with 925MBq (99m)Tc-MDP revealed the presence of bone metastatic lesions in 50 patients (29 with more than 3 lesions and 21 with less than 3 lesions). The other 42 patients had no bone metastases. The patients and the control group were re-evaluated after 1 year. Our results showed that serum CgA positively correlated with multiple bone metastases and higher Gleason score, serum levels of CgA and PSA. Levels of PSA were significantly higher in patients with PAC and bone metastases compared with those with no bone metastases (P<0.001). In patients with multiple bone metastases and Gleason Score >7 elevated serum levels of CgA higher than those of PSA were found. In conclusion, serum CgA levels is a valuable marker for predicting the presence of multiple bone metastases in PAC patients. Combined with PSA, CgA can predict disease progression in patients with advanced PAC under CAND treatment and is correlated with poor prognosis.

Four prognostic indices in advanced prostate cancer patients, under palliative androgen deprivation treatment.

Prostate cancer (PCa) is the second leading cause of death in men aged 40 years and older ]and prognostic indices are useful in suggesting its proper treatment. The aim of this study was to evaluate the prognostic value of Gleason score (GS), TNM staging system, initial serum prostate specific antigen (PSA) and bone scintigraphy (BS) in patients with PCa under hormonal palliative treatment, in the development and progression of recurrent PCa. Our methods were as follows: Between January 2005 and December 2007, we have studied at the University General Hospital of Alexandroupolis fourty patients of mean age 77+/-7.2 years with advanced PCa under palliative treatment with antiandrogens and luteinizing hormone-releasing hormone analogues. PCa was diagnosed histologically, based on the TNM system after transrectal ultrasonography guided biopsy. The Gleason score assessment was made as described by others. Metastases were confirmed by a positive bone scintigraphy with 925 MBq (99m)Tc-MDP using a tomographic gamma camera, computerized axial tomography or magnetic resonance imagining. Measurements of PSA were conducted by the radioimmunoassay method. We also examined 20 healthy blood donors (median age 45+/-6.1 years) as controls, in order to estimate the cut-off value of PSA. Our results show the following: Thirteen of our patients had 1-6 "hot" spots and 27 had more than 6 "hot" spots in the bone scan. The median Gleason score was 7 (modal Gleason score 3+4). Serum PSA levels were higher in patients with PCa and bone metastases in comparison to those with PCa without bone metastases. Very high values of PSA (more than 50 ng/ml) were found in patients with multiple bone metastases (>6 "hot" spots). In conclusion, our findings demonstrate that the prognostic value of GS (P=0.043), TNM staging (P=0.1410), serum PSA levels (P=0.002) and BS (P=0.0135) when used alone, not always improve the prognosis to hormone indepentent but when combined (P<0.001) increase the prognosis in patients with advanced PCa under hormonal palliative treatment.

The expression of metallothioneins on imprint smears of prostate carcinoma: correlation with clinicopathologic parameters and tumor proliferative capacity.

AIMS AND BACKGROUND: Metallothioneins are a family of metalbinding cysteine-rich proteins that play an important role in cellular processes such as proliferation and apoptosis, protection against oxidative stress and metal ion homeostasis and detoxification. Recent findings suggest that metallothioneins might play a significant role in the development and progression of prostate cancer. It has been also demonstrated that Ki67 expression may have prognostic value for disease-free survival in cases of prostate carcinoma. STUDY DESIGN: Imprint smears samples obtained from 70 patients immediately after radical prostatectomy for prostatic carcinoma were immunostained with monoclonal antibodies against metallothioneins and Ki-67. Metallothionein expression was correlated with Ki-67 immunostaining, Gleason score, stage, preoperative prostate-specific antigen levels and biochemical recurrence. RESULTS: Metallothionein expression was shown to correlate strongly with Gleason score (P < 0.001) and significantly with pathological staging and Ki-67 immunostaining (P < 0.001, P < 0.05, respectively). In contrast, no significant association between metallothioneins and preoperative PSA was demonstrated. Both of the studied markers (metallothioneins and Ki-67) correlated with recurrence (P = 0.009, P = 0.006, respectively). CONCLUSIONS: The present findings support the independent predictive value of metallothioneins and Ki-67 in prostate cancer. However, additional data are needed in order to reveal the factors that influence the expression of metallothioneins in epithelial neoplastic cells and clarify their mechanism of action.

[Serum testosterone, dihydrotestosterone, luteinizing hormone and follicle-stimulating hormone versus prostate specific antigen in patients with localized prostate adenocarcinoma who underwent radical prostatectomy. Radioimmunoassays measurements].

The relation of steroid hormones (SH) with carcinogenesis is not well understood. There is a variation of opinions among researchers about the prognostic value of serum SH in patients with localized prostate cancer (PC). The aim of this was to study serum SH in patients with localized PC before and after radical prostatectomy (RP). Seventy patients with mean age 67+/-8 years, were studied. The diagnosis was confirmed by histology after a biopsy. None of the patients was submitted to hormonal treatment or radiotherapy prior to RP. Serum testosterone (TST), dihydrotestosterone (DHT), luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels were examined prior RP and one year following RP, by radioimmuno assay (RIA) or immunoradiometric assay (IRMA) methods. Based on serum PSA levels before and one year after RP, 66 of the patients did not have biochemical recurrence while 4 patients developed biochemical recurrence due to residual disease and were treated with flutamide and a LH-RH analogue. In the group of 66 patients there was a statistically significant increase in serum TST (P<0.001), LH (P=0.004) and FSH (P<0.001), and statistically significant decrease in serum DHT (P<0.001). In the four patients with biochemical recurrence, TST increased and serum DHT, LH and FSH decreased. In this group the reduction of DHT and LH, FSH were due to treatment with flutamide and a LH-RH analogue respectively. Our findings suggest that after RP increase of serum LH and FSH may have caused an increase in serum TSH and a decrease of serum DHT. If those changes are due to the hypothalamic-pituitary axis it may be that the prostate neoplasm before RP may have secreted a substance that induced a negative feedback to the pituitary gonadotrophin secretion, which was unrelated to varying serum PSA levels.

[Correlation of serum prostate specific antigen, the volume and the intravesical prostatic protrusion for diagnosing bladder outlet obstruction in patients with benign prostate hyperplasia].

Benign prostate hyperplasia (BPH) is common in elderly men. Nevertheless, the pathophysiology of low urinary tract symptoms (LUTS) may not be due only to BPH. Many men with LUTS are submitted to unnecessary medications or surgical interventions because their symptoms have not been correctly evaluated. Can diagnostic test such as serum prostate antigen (PSA), performed by nuclear medicine techniques and the trans-abdominal ultrasound determine with high sensitivity whether LUTS is due exclusively to BPH? The aim of the study was to correlate serum PSA, prostate volume (PV), intravesical prostatic protrusion (IPP), uroflowmetry measuring maximal urine flow/sec (Qmax), and the international prostate symptom score (IPSS) questionnaire, to estimate urine bladder outlet obstruction (BOO), in patients with BPH. A hundred and twelve patients with mean of age 72 +/- 8 years and LUTS were studied. All patients were examined according to the IPSS questionnaire, had their serum PSA tested and also Qmax of prostate volume and IPP by trans-abdominal ultrasound were examined. The patients were separated in groups according to serum PSA values (or= 4.1 ng/ml), prostate volume (PV< 20.20-40 and > 20 ml) and the intravesical prostatic protrusion (IPP < 5.5-10.10 mm). There was a statistical correlation between the BOO and: a) PSA (P = 0.004), b) prostate volume with P of < 0.001) and c) IPP = 0.005. On the contrary, there was no statistical correlation between BOO and IPSS, Qmax with P values 0.228 and 0.745 respectively. Receiving operating curve (ROC) showed that patients with a serum PSA value of 1.5-4 ng/ml, IPP of type II and PV 20-40 ml, had a sensitivity of 48% for PSA, of 50% for PV and of 47% for IPP and a specificity of 75%, 47% and 60% respectively. In conclusion, according to the results of this study, a more objective evaluation of BOO, which is exclusively due to BPH, should include, not only PV but also serum PSA values and IPP.

Perforation of the urinary bladder caused by transurethral insertion of a pencil for the purpose of masturbation in a 29-year-old female.

The urethra is a usual site of introduction of foreign bodies for autoerotic stimulation. We present an unusual case of bladder perforation caused by foreign body that was self-inserted in the urethra and consequently slipped inside the bladder in a 29-year-old female patient with psychiatric disease. The patient was referred to our department for macroscopic hematuria and abdominal pain. Imaging studies revealed the presence of a foreign body in the pelvic area which had perforated the left lateral wall of the bladder. The foreign body was removed via open cystotomy. In psychiatric patients hematuria and pelvic pain may result from insertion of a foreign body in the bladder usually during masturbation.