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Alves KC, Bonnet-Serrano F, Laguillier C, Akiki V, Dehghani L, Larger É, Leguy MC, Guibourdenche J. [Proinsulin: physiology, measurement, and interest in clinical biology]. Ann Biol Clin (Paris) 2023; 81:abc.2023.1838. [PMID: 38018823 DOI: 10.1684/abc.2023.1838] [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: 11/30/2023]
Abstract
The proinsulin molecule results from the cleavage of pre-pro-insulin, produced in pancreatic beta cells. Its subsequent -cleavage allows the release of insulin, the key hormone of glycemia regulation and C-peptide in equimolar proportions. During fasting trial, insulinoma diagnosis relies on inadequately high insulin and C-peptide serum levels concomitant with an hypoglycemia. In this context, proinsulin assay can be interesting in the cases of discrepancy between the two parameters. In diabetes, endoplasmic reticulum stress and beta cells inflammation, lead to the secretion of misfolded proinsulin molecules. Thus, in type 2 diabetes, proinsulin/insulin ratio increases with the degree of insulin resistance. In type 1 diabetes, proinsulin/C-peptide ratio could predict the onset of diabetes in relatives. In our practice, serum pro-insulin determined using an Elisa immunoassay (Millipore®) during fasting trial can be complementary to C-peptide and insulin assays in relation to glycemia to label an hypoglycemia. In case of glucose intolerance and diabetes, proinsulin could thus be measured.
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Affiliation(s)
- Katia Carvalho Alves
- UF d'Hormonologie, CHU Cochin, AP-HP, 27 rue du Faubourg Saint-Jacques, 75679 Paris cedex 14, France
| | - Fidéline Bonnet-Serrano
- UF d'Hormonologie, CHU Cochin, AP-HP, 27 rue du Faubourg Saint-Jacques, 75679 Paris cedex 14, France
| | - Christelle Laguillier
- UF d'Hormonologie, CHU Cochin, AP-HP, 27 rue du Faubourg Saint-Jacques, 75679 Paris cedex 14, France
| | - Vanessa Akiki
- Service de Diabétologie, CHU Cochin, AP-HP, 27 rue du Faubourg Saint-Jacques, 75679 Paris cedex 14, France
| | - Léa Dehghani
- Service de Diabétologie, CHU Cochin, AP-HP, 27 rue du Faubourg Saint-Jacques, 75679 Paris cedex 14, France
| | - Étienne Larger
- Service de Diabétologie, CHU Cochin, AP-HP, 27 rue du Faubourg Saint-Jacques, 75679 Paris cedex 14, France
| | - Marie-Clémence Leguy
- UF d'Hormonologie, CHU Cochin, AP-HP, 27 rue du Faubourg Saint-Jacques, 75679 Paris cedex 14, France
| | - Jean Guibourdenche
- UF d'Hormonologie, CHU Cochin, AP-HP, 27 rue du Faubourg Saint-Jacques, 75679 Paris cedex 14, France
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Hassan B, Yazbeck Y, Akiki V, Salti I, Tfayli A. ACTH-secreting metastatic prostate cancer with neuroendocrine differentiation. BMJ Case Rep 2022; 15:15/12/e247997. [PMID: 36535741 PMCID: PMC9764653 DOI: 10.1136/bcr-2021-247997] [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: 12/23/2022] Open
Abstract
Cushing's syndrome (CS) due to ectopic adrenocorticotropic hormone (ACTH) secretion (EAS) can result from a variety of tumours and rarely from those of prostatic origin. We present a male patient in his early 60s with ACTH-secreting metastatic prostate adenocarcinoma with neuroendocrine differentiation (ICD-O code 8574/3) years after prostatectomy and androgen-deprivation therapy, initially presenting with Cushingoid features. After open radical prostatectomy and bilateral orchiectomy for disease recurrence, the patient was found to have metastatic liver and bone lesions highly suggestive of metastatic prostatic cancer. About 10% of cells on liver biopsy expressed ACTH, a finding consistent with EAS as the cause of CS. His stay was complicated with multiple infections and ultimate death. Hence, we report a case of metastatic prostate adenocarcinoma with neuroendocrine differentiation who presented with CS. We also emphasize the importance of adequate and timely treatment.
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Affiliation(s)
- Bashar Hassan
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Yara Yazbeck
- Division of Endocrinology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Vanessa Akiki
- Division of Endocrinology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ibrahim Salti
- Division of Endocrinology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Arafat Tfayli
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Holmes LC, Orom H, Lehman HK, Lampkin S, Halterman JS, Akiki V, Supernault-Sarker AA, Butler SB, Piechowski D, Sorrentino PM, Chen Z, Wilding GE. A pilot school-based health center intervention to improve asthma chronic care in high-poverty schools. J Asthma 2022; 59:523-535. [PMID: 33322963 PMCID: PMC8281495 DOI: 10.1080/02770903.2020.1864823] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 12/16/2022]
Abstract
OBJECTIVE To test the feasibility and effectiveness of a multifaceted intervention administered through school-based health centers (SBHCs) to improve asthma control for children in high-poverty schools with not well controlled asthma. METHODS Students 4-14 years old with persistent asthma were enrolled from three SBHCs. The centers' advanced practice providers received training on evidence-based asthma guidelines. Students randomized to the intervention received directly observed therapy of their asthma controller medication, medication adjustments as needed by the centers' providers, and daily self-management support. Students randomized to usual care were referred back to their primary care provider (PCP) for routine asthma care. RESULTS We enrolled 29 students. Students in the intervention group received their controller medication 92% of days they were in school. Ninety-four percent of follow-up assessments were completed. During the study, 11 of 12 intervention students had a step-up in medication; 2 of 15 usual care students were stepped up by their PCP. Asthma Control Test scores did not differ between groups, although there were significant improvements from baseline to the 7 month follow-up within each group (both p < .01). Both FEV1% predicted and FEV1/FVC ratio significantly worsened in the usual care group (both p = .001), but did not change in the intervention group (p = .76 and .28 respectively). CONCLUSIONS Our pilot data suggest that a multifaceted intervention can be feasibly administered through SBHCs in communities with health disparities. Despite the small sample size, spirometry detected advantages in the intervention group. Further study is needed to optimize the intervention and evaluate outcomes. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT03032744.
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Affiliation(s)
- Lucy C. Holmes
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA,Corresponding author: Lucy C. Holmes, Department of Pediatrics, 1001 Main Street, Buffalo, New York 14203, (716) 323-0034,
| | - Heather Orom
- Department of Community Health and Health Behavior, University at Buffalo School of Public Health and Health Professions, Buffalo, NY, USA
| | - Heather K. Lehman
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Stacie Lampkin
- Department of Pharmacy Practice, D’Youville College, Buffalo, NY, USA
| | - Jill S. Halterman
- Department of Pediatrics, University of Rochester School of Medicine, Rochester, NY, USA
| | - Vanessa Akiki
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Alicia A. Supernault-Sarker
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | | | - Denise Piechowski
- John R. Oishei Children’s Hospital, Kaleida Health, Buffalo, NY, USA
| | | | - Ziqiang Chen
- Department of Biostatistics, University at Buffalo School of Public Health and Health Professions, Buffalo, NY USA
| | - Gregory E. Wilding
- Department of Biostatistics, University at Buffalo School of Public Health and Health Professions, Buffalo, NY USA
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Assi HI, Alameh IA, Khoury J, Bou Zerdan M, Akiki V, Charafeddine M, El Saheb GI, Sukhon F, Sbaity E, Baydoun S, Shabb N, Berjawi G, Haidar MB. Diagnostic Performance of FDG-PET/CT Scan as Compared to US-Guided FNA in Prediction of Axillary Lymph Node Involvement in Breast Cancer Patients. Front Oncol 2021; 11:740336. [PMID: 34660301 PMCID: PMC8518554 DOI: 10.3389/fonc.2021.740336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Received: 07/12/2021] [Accepted: 09/13/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose The aim of this study was to evaluate the diagnostic ability of 2-deoxy-2-[fluorine-18]fluoro-d-glucose (18F-FDG) PET/non-contrast CT compared with those of ultrasound (US)-guided fine needle aspiration (FNA) for axillary lymph node (ALN) staging in breast cancer patients. Patients and Methods Preoperative 18F-FDG PET/non-contrast CT was performed in 268 women with breast cancer, as well as ALN dissection or sentinel lymph node (SLN) biopsy. One hundred sixty-four patients underwent US-guided FNA in combination with 18F-FDG PET/CT. The diagnostic performance of each modality was evaluated using histopathologic assessments as the reference standard. The receiver operating characteristic (ROC) curves were compared to evaluate the diagnostic ability of several imaging modalities. Results Axillary 18F-FDG uptake was positive in 180 patients, and 125 patients had axillary metastases according to the final pathology obtained by ALN dissection and/or SLN dissection. Of the patients with positive 18F-FDG uptake in the axilla, 21% had false-positive results, whereas 79% were truly positive. Eighty-eight patients had negative 18F-FDG uptake in the axilla, among which 25% were false-negative. 18F-FDG-PET/CT had a sensitivity of 86.59% and a specificity of 63.46% in the assessment of ALN metastasis; on the other hand, US-guided FNA had a sensitivity of 91.67% and a specificity of 87.50%. The mean primary cancer size (p = 0.04) and tumor grade (p = 0.04) in combination were the only factors associated with the accuracy of 18F-FDG PET/CT for detecting metastatic ALNs. Conclusion The diagnostic performance of 18F-FDG PET/CT for the detection of axillary node metastasis in breast cancer patients was not significantly different from that of US-guided FNA. Combining 18F-FDG PET/CT with US-guided FNA or SLN biopsy could improve the diagnostic performance compared to 18F-FDG PET/CT alone.
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Affiliation(s)
- Hazem I Assi
- Department of Internal Medicine, Division of Hematology and Oncology, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ibrahim A Alameh
- Department of Internal Medicine, Division of Hematology and Oncology, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jessica Khoury
- Department of Internal Medicine, Division of Hematology and Oncology, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Maroun Bou Zerdan
- Department of Internal Medicine, Division of Hematology and Oncology, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Vanessa Akiki
- Department of Internal Medicine, Division of Endocrinology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Maya Charafeddine
- Department of Internal Medicine, Division of Hematology and Oncology, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ghida I El Saheb
- Department of Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fares Sukhon
- Department of Internal Medicine, Division of Hematology and Oncology, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Eman Sbaity
- Department of General Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Serine Baydoun
- Department of Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nina Shabb
- Department of Pathology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ghina Berjawi
- Department of Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mohamad B Haidar
- Department of Radiology, American University of Beirut Medical Center, Beirut, Lebanon
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Kossaify A, Akiki V. Echocardiographic assessment of mitral valve regurgitation, pattern and prevalence, expanding clinical awareness through an institutional survey with the perspective of a quality improvement project. Clin Med Insights Cardiol 2014; 8:71-7. [PMID: 25210482 PMCID: PMC4149403 DOI: 10.4137/cmc.s17367] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 07/09/2014] [Accepted: 07/15/2014] [Indexed: 11/05/2022]
Abstract
BACKGROUND Mitral regurgitation (MR) is frequently reported in everyday echocardiograms; accurate assessment is essential for appropriate management and decision making. OBJECTIVE We performed a self-audit in order to define the prevalence and pattern of MR and to evaluate methods of assessment with the perspective of developing a quality improvement project. METHODS AND SETTING This retrospective analytical study was conducted in a university hospital. INCLUSION CRITERIA age more than 18 years and medical records available within the facility, including a "complete" medical history. Using the picture archiving and communication system, we reviewed 961 echocardiograms performed over a 6-month period. The methods of assessment of native mitral valve regurgitation were reported, and also relevant medical data were collected using an electronic archiving system. RESULTS AND DISCUSSION Among the 961 patients reviewed, 322 (33.50%) had MR, with variable grades. MR pattern (organic versus functional) was not specified in 49.68% of cases. "Eyeball" assessment and "color jet area" were the most frequently used methods for MR assessment (90.06% and 27.95%, respectively), while "vena contracta" and "flow convergence" methods were rarely implemented (1.55% and 2.17%, respectively). Discussion is made according to current guidelines, while showing the strengths and weaknesses of each method. CONCLUSION The prevalence of MR was 33.50%, and in nearly half of cases, the MR pattern was not specified. Qualitative and semi-quantitative methods of assessment were mostly used; quantitative assessment should be implemented more frequently, in accordance with current guidelines. Increasing clinical awareness by creating and implementing a quality improvement project is essential in this context.
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Affiliation(s)
- Antoine Kossaify
- Echocardiography unit, Cardiology division, USEK-University Hospital Notre Dame de Secours, St Charbel Street, Byblos, Lebanon
| | - Vanessa Akiki
- Echocardiography unit, Cardiology division, USEK-University Hospital Notre Dame de Secours, St Charbel Street, Byblos, Lebanon
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