International survey on complications of religious fasting after metabolic and bariatric surgery

Religious fasting in Ramadan the 9th month of the lunar year is one of five pillars in Islam and is practiced for a full month every year. There may be risks with fasting in patients with a history of metabolic/bariatric surgery (MBS). There is little published evidence on the possible complications during fasting and needs stronger recommendations and guidance to minimize them. An international survey was sent to surgeons to study the types of complications occurring during religious fasting in patients with history of MBS to evaluate the risk factors to manage and prepare more evidence-based recommendations. In total, 21 centers from 11 countries participated in this survey and reported a total of 132 patients with complications occurring during religious fasting after MBS. The mean age of patients with complications was 36.65 ± 3.48 years and mean BMI was 43.12 ± 6.86 kg/m2. Mean timing of complication occurring during fasting after MBS was 14.18 months. The most common complications were upper GI (gastrointestinal) symptoms including [gastroesophageal reflux disease (GERD), abdominal pain, and dyspepsia], marginal ulcers and dumping syndrome in 24% (32/132), 8.3% (11/132) and 23% (31/132) patients respectively. Surgical management was necessary in 4.5% of patients presenting with complications (6/132) patients due to perforated marginal or peptic ulcer in Single Anastomosis Duodenoileostomy with Sleeve gastrectomy (SADI-S), one anastomosis gastric bypass (OAGB) and sleeve gastrectomy (SG), obstruction at Jejunojenostomy after Roux-en-Y gastric bypass (RYGB) (1/6) and acute cholecystitis (1/6). Patients after MBS should be advised about the risks while fasting including abdominal pain, dehydration, and peptic ulcer disease exacerbation, and a thorough review of their medications is warranted to minimize complications.

Dual-Centre Harmonised Multimodal Positron Emission Tomography/Computed Tomography Image Radiomic Features and Machine Learning Algorithms for Non-small Cell Lung Cancer Histopathological Subtype Phenotype Decoding

AIMS

We aimed to build radiomic models for classifying non-small cell lung cancer (NSCLC) histopathological subtypes through a dual-centre dataset and comprehensively evaluate the effect of ComBat harmonisation on the performance of single- and multimodality radiomic models.

MATERIALS AND METHODS

A public dataset of NSCLC patients from two independent centres was used. Two image fusion methods, namely guided filtering-based fusion and image fusion based on visual saliency map and weighted least square optimisation, were used. Radiomic features were extracted from each scan, including first-order, texture and moment-invariant features. Subsequently, ComBat harmonisation was applied to the extracted features from computed tomography (CT), positron emission tomography (PET) and fused images to correct the centre effect. For feature selection, least absolute shrinkage and selection operator (Lasso) and recursive feature elimination (RFE) were investigated. For machine learning, logistic regression (LR), support vector machine (SVM) and AdaBoost were evaluated for classifying NSCLC subtypes. Training and evaluation of the models were carried out in a robust framework to offset plausible errors and performance was reported using area under the curve, balanced accuracy, sensitivity and specificity before and after harmonisation. N-way ANOVA was used to assess the effect of different factors on the performance of the models.

RESULTS

Support vector machine fed with selected features by recursive feature elimination from a harmonised PET feature set achieved the highest performance (area under the curve = 0.82) in classifying NSCLC histopathological subtypes. Although the performance of the models did not significantly improve for CT images after harmonisation, the performance of PET and guided filtering-based fusion feature signatures significantly improved for almost all models. Although the selection of the image modality and feature selection methods was effective on the performance of the model (ANOVA P-values <0.001), machine learning and harmonisation did not change the performance significantly (ANOVA P-values = 0.839 and 0.292, respectively).

CONCLUSION

This study confirmed the potential of radiomic analysis on PET, CT and hybrid images for histopathological classification of NSCLC subtypes.

Reference range of testosterone and dehydroepiandrosterone sulfate levels in women during reproductive age in the Iranian population

Backgrounds

To determine the average cutoff values of serum-free and total testosterone (FT, TT) and dehydroepiandrosterone sulfate (DHEAS) among healthy premenopausal women.

Materials and Methods

Participants were women aged 18-55 years without signs and symptoms of hyperandrogenism (n = 489). Participants if Ferriman-Gallwey (FG) scores between 6 and 8 were considered a group located in the upper spectrum related to the normal hirsutism score (n = 30). DHEAS, TT, and FT levels were compared between different populations. Upper limits of 97.5 and 95 and lower limits of 5 and 2.5 percentiles were calculated to provide the reference intervals for DHEA, TT, and FT in the total sample and in the population with FG 6-8.

Results

In the total population, the mean ± standard deviation (SD) serum FT, TT, and DHEAS levels were 1.40 ± 0.63 pg/mL, 0.42 ± 0.17 ng/mL, and 1.5 ± 0.97 µg/ml, respectively. The cutoff values of FT at 1.35 and TT at 0.49 were obtained for differentiating the patients with FG 6-8 scores from the normal population, with the corresponding specificity of 0.60, the sensitivity of 0.67, and area under the ROC curve (AUC) (confidence interval 95%) of 0.63 (0.52-0.73), P = 0.01 and 0.68 (0.58-0.78) P = 0.001, respectively.

Conclusions

In our study, the mean ± SD serum FT level was 1.40 ± 0.63 pg/mL, the TT level was 0.42 ± 0.17 ng/mL, and the DHEAS level was 1.5 ± 0.97 µg/ml, in premenopausal women between 18 and 49 years of age. Furthermore, in a population with FG 6-8 score, a cutoff value of FT at 1.35 and TT at 0.49 was obtained. Although the irregular menstrual cycle did not change the reference range when compared with the normal group.

A Systematic Review and Meta-Analysis of Vitamin D Status of Patients with Severe Obesity in Various Regions Worldwide

INTRODUCTION

Managing nutritional deficiencies is an essential component in the treatment of severe obesity. Vitamin D deficiency is often reported in investigations in severely obese cohorts. However, no prior study has summarized findings on this topic. Consequently, the aim of this systematic review and meta-analysis was to investigate the 25-hydroxyvitamin D [25(OH)D] status in individuals with severe obesity in different regions worldwide. We also evaluated levels of calcium, parathyroid hormone (PTH), and magnesium as secondary outcome measures.

METHODS

We searched Medline, PubMed, Scopus, the Cochrane Library, and EMBASE for relevant observational studies published in English from 2009 to October 2021. The heterogeneity index among the studies was determined using the Cochran (Q) and I2 tests. Based on the heterogeneity results, the random-effect model was applied to estimate the prevalence of vitamin D deficiency.

RESULTS

We identified 109 eligible observational studies. Overall, 59.44% of patients had vitamin D deficiency [25(OH)D <20 ng/mL], whereas 26.95% had vitamin D insufficiency [25(OH)D 20-30 ng/mL]. Moreover, the mean 25(OH)D level was 18.65 ng/mL in 96 studies. The pooled mean estimate of the serum calcium, PTH, and magnesium was 9.26 mg/dL (95% confidence interval [CI]: 9.19-9.32, I2 = 99.7%, p < 0.001), 59.24 pg/mL (95% CI: 54.98, 63.51, I2 = 99.7%, p < 0.001), and 0.91 mg/dL (95% CI: 0.84, 0.98, I2 = 100.0%, p < 0.001), respectively. The results of the subgroup analysis indicated that the mean estimates of 25(OH)D were highest in North America (21.71 ng/mL [19.69, 23.74], [I2 = 97.2%, p < 0.001]) and lowest in Southeast Asia (14.93 ng/mL [14.54, 15.33], [I2 = 0.0%, p = 0.778]).

CONCLUSION

The results obtained showed a significant prevalence of vitamin D deficiency among severely obese individuals in various geographical regions, whereas the highest and lowest mean estimates were reported for North America and Southeast Asia, respectively.

The impact of laparoscopic Roux-en-Y gastric bypass on sleep quality and duration after one year of follow-up

BACKGROUND AND AIMS

Several studies have shown the association between obesity and sleep. Roux-en-Y gastric bypass (RYGB) surgery may improve sleep disturbances in patients with obesity by influencing a variety of factors. This study aims to evaluate the impact of bariatric surgery on sleep quality.

METHODS

Patients with severe obesity referred to the obesity clinic of a center from September 2019 to October 2021 were collected. The patients were divided into two groups, depending on whether they underwent RYGB surgery. Medical comorbidities and self-report questionnaires regarding sleep quality, anxiety, and depression were collected at baseline and 1-year follow-up.

RESULTS

54 patients were included, including 25 in the bariatric surgery group and 29 in the control group. However, five patients in the RYGB surgery group and four patients in the control group were lost in the follow-up. Pittsburgh Sleep Quality Index (PSQI) was decreased from a mean of 7.7 to 3.8 in the bariatric surgery group (p-value<0.001). In contrast to the control group, the number of patients with obstructive sleep apnea was significantly reduced in the bariatric surgery group.

CONCLUSIONS

We showed a significant improvement in sleep quality following RYGB surgery. Obstructive sleep apnea, obesity/overweight, and depressive symptoms significantly improved in our study. There is a lack of a better understanding of the association between these factors and sleep quality following surgery. Therefore, further studies are recommended regarding this issue.

Frequent Monitoring of Blood Glucose Levels via a Remote Patient Monitoring System Helps Improve Glycemic Control

OBJECTIVE

This study aims to evaluate the effectiveness of the Vivovitals diabetes platform on improving glycemic control and reducing A1C in patients with uncontrolled type II diabetes mellitus by providing more accessible and direct patient care under the monitoring and oversight of their physician.

METHODS

This 12-week, prospective, pragmatic, single-center, double-arm study assessed the impact of the Vivovitals diabetes platform on glycemic control among 78 adults ≥ 18 years of age, with A1C ≥ 7.5% (58 mmol/mol) at baseline. The participants were randomized into two groups. The control group received usual clinic care, while the intervention group was provided with a smartphone linked telehealth application, a pre-configured glucometer, and access to the glycemic readings diary. Blood glucose levels of the intervention group were transmitted to the providers daily. Patients whose blood glucose levels were <70 mg/dL or >180mg/dL were contacted, and modifications were made to diet and medication. The two groups were compared at baseline and 12 weeks using nonparametric tests with p<0.05 considered statistically significant.

RESULTS

Over 12 weeks, the average A1C in the control group reduced by 0.474% (p=0.533; 95% CI: -0.425, -0.523) whereas the average A1C in the intervention group reduced 1.70% (p=0.002; 95% CI: -1.02, -2.39). The estimated treatment difference was expressed via Cohen's d which yielded 0.62. After 12 weeks, A1C values between the control and intervention groups were statistically significant (p = 0.001).

CONCLUSION

Use of the Vivovitals platform may help to improve glycemic control among individuals with type 2 diabetes mellitus.

Permanent complications after thyroid surgery and effect of surgeon volume

Introduction: Thyroidectomy is a surgical method for the management of benign and malignant thyroid disease. Thyroidectomy may cause significant complications including hypocalcemia and recurrent laryngeal nerve injury. Permanent complications after thyroid surgery pose significant costs for healthcare system, as patients require lifelong alternative treatments and healthcare facilities. Objectives: The purpose of this study was to evaluate the incidence and risk factors for permanent complications following thyroidectomy. Patients and Methods: A total of 204 consecutive patients who underwent thyroid surgery between 2017 and 2018 were included in this prospective study. The patients were followed for 12 months after surgery and clinical and biochemical data were recorded. Results: The incidence of transient and permanent hypocalcemia was 46.8% and 6.38%, respectively. Transient hoarseness affected 30.3% of patients and 2.1% had recurrent laryngeal nerve paralysis as detected by video laryngoscopy 12 months after surgery. Surgeons volume was significantly related to the presence of permanent hypocalcemia (P=0.003). In comparison to high-volume-surgeons, intermediate-volume-surgeons had an odds ratio of 5.25 (P=0.042) for permanent complications. Conclusion: Hypocalcaemia remained the most common long-term complication of thyroid surgery. High volume surgeons had lower complication rates and better outcomes. In this regard, methods for improving surgical performance are worthy of investigation.

The Impact of Obesity Surgery on Serum Uric Acid in People With Severe Obesity: A Retrospective Study

Studies indicate an association between hyperuricemia (HUA) and metabolic syndrome risk factors. On the other hand, obesity is a major modifiable and independent risk factor for HUA and gout. However, evidence concerning the effects of bariatric surgery on serum uric acid levels is limited and not completely clarified. This retrospective study was carried out with 41 patients who underwent sleeve gastrectomy (n = 26) and Roux-en-Y gastric bypass (n = 15) from September 2019 to October 2021. Anthropometric, clinical, and biochemical data, including uric acid blood urea nitrogen and creatinine fasting blood sugar (FBS), serum triglyceride (TG), and serum cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), were measured preoperatively and postoperative 3, 6 and 12 months. From baseline to 6 and 12 months, bariatric surgery resulted in a significant decrease in serum uric acid of patients with severe obesity (p < 0.001). The decreases in serum FBS, TG, and cholesterol of patients were significant during 6 and 12 months of follow-up (p < 0.05). However, the HDL increase of patients was not statistically significant in 6 and 12 months (p > 0.05). Besides, although patients' serum level of LDL decreased significantly during the 6 months of follow-up (p = 0.007), it was not significant after 12 months (p = 0.092). Bariatric surgery significantly reduces serum uric acid levels. Therefore, it may be an effective supplementary therapy for lowering serum uric acid concentrations in morbidly obese patients.

Estimating the parameters of a dependent model and applying it to environmental data set

In this paper, a new dependent model is introduced. The model is motivated using the structure of series-parallel systems consisting of two series-parallel systems with a random number of parallel sub-systems that have fixed components connected in series. The dependence properties of the proposed model are studied. Two estimation methods, namely the moment method, and the maximum likelihood method are applied to estimate the parameters of the distributions of the components based on observing the system's lifetime data. A Monte Carlo simulation study is used to evaluate the performance of the estimators. Two real data sets are used to illustrate the proposed method. The results are useful for researchers and practitioners interested in analyzing bivariate data related to extreme events.

Impact of the COVID-19 Pandemic on the Success of Bariatric Surgeries in Patients with Severe Obesity

INTRODUCTION

SARS-CoV-2 infection (COVID-19) pandemic may influence the weight outcomes of bariatric surgeries (BS). Here, we intended to compare the weight outcome of patients who underwent BS before and during the pandemic time.

METHODS

In a retrospective, single-center study, the information of two groups of patients; first COVID-19 group (n = 51) consisted of those that underwent BS during the pandemic and completed a year of follow-up, second non-COVID-19 group included 50 patients who underwent BS and were followed up before the pandemic. All the patients' anthropometric and obesity-related disease data were compared between groups.

RESULTS

Weight loss and the decrease of body mass index 1 year after the surgery, as well as excess weight loss and total weight loss, were significantly higher in the non-COVID-19 group compared to the COVID-19 group (p < 0.05). Although the rate of remission for diabetes mellitus, hypertension, and dyslipidemia was higher in the non-COVID-19 group, the differences were not statistically significant (p > 0.05).

CONCLUSION

We showed a significantly poorer weight outcome at the 1-year follow-up of the BS during the pandemic compared to the pre-pandemic. These results need further investigations to determine the preventive measures and management by evaluating the associated factors.

Effect of oral magnesium supplement on cardiometabolic markers in people with prediabetes: a double blind randomized controlled clinical trial

To evaluate the effect of magnesium supplementation on insulin resistance and cardiovascular markers in people with prediabetes. A 12 week double-blind placebo-controlled randomized clinical trial was conducted at Isfahan Endocrine and Metabolism Research Center, Iran, on people with prediabetes (n = 86) to compare the effects of magnesium oxide 250 mg/day versus a placebo on anthropometric indices, blood pressure, fasting glucose, insulin, HOMA-IR index, C-reactive protein, uric acid and lipid profile. Both groups had similar distributions of anthropometric and biochemical variables at baseline. Those who received magnesium supplementation had significantly higher levels of HDL-cholesterol compared to the placebo group at the end of the study (49.7 ± 10.9 vs 43.6 ± 7.2 mg/dL, P = 0.003). The mean changes of HOMA-IR index, total cholesterol, LDL-cholesterol, triglyceride, uric acid and C-reactive protein levels as well as anthropometric indices and blood pressure in supplemented and placebo groups did not differ significantly. Magnesium supplementation increased HDL-cholesterol levels in people with prediabetes. However, other cardiometabolic markers were not improved by magnesium supplementation at the above dosage and duration.

Isfahan Thyroid Cohort Study (ITCS)

BACKGROUND

The Isfahan Thyroid Cohort Study (ITCS) is one of the few population-based epidemiological studies in Iran that investigates the prevalence and incidence of thyroid disorders including hypothyroidism, hyperthyroidism, goiter, nodule, and iodine status.

METHODS

This cohort is located in Isfahan, Iran. The first phase was initiated in 2006 with 2523 participants (1275 males, 1248 females). The participants were selected using multi-stage cluster sampling from the general residents of Isfahan, Iran. The study had two phases (2006 and 2011) and its third stage is planned for 2020-2021.

RESULTS

The prevalence of thyroid function states was euthyroid (89.3%, 95% CI: 88%-90%), overt hypothyroidism (2.8%, 95% CI: 2%‒3%), subclinical hypothyroidism (5.8%, 95% CI: 4%-6%), overt hyperthyroidism (0.8%, 95% CI: 0.4%‒1%), and subclinical hyperthyroidism (0.99%, 95% CI: 0.6%-1%). Hypothyroidism and hyperthyroidism were significantly associated with goiter. The incidence of thyroid dysfunction was reported as follows: overt hypothyroidism (2.7, 95% CI: 1.6-3.7), subclinical hypothyroidism (20.6, 95% CI: 18-23), overt hyperthyroidism (1.9, 95% CI: 1-2.7) and subclinical hyperthyroidism (2.7, 95% CI: 1.6-3.7) per 1000 (person-year).

CONCLUSION

We assessed the prevalence and incidence of thyroid disorders in Isfahan in the first and second phase, respectively. We are conducting the third phase of the ITCS in order to study the associations between thyroid peroxidase antibody (TPOAb) level and environmental factors such as infection.

Bariatric Surgery and COVID-19: What We Have Learned from the Pandemic in Iran: a Retrospective Observational Cohort Study

PURPOSE

Little is known about the symptoms of coronavirus disease 2019 (COVID-19) on patients with morbid obesity following bariatric surgery (BS) in Iran. Thus, we sought to investigate the symptoms and effect of COVID-19 in patients with morbid obesity following, or candidates for, BS in Iran.

MATERIALS AND METHODS

In this retrospective observational cohort study, we enrolled 236 morbid obese patients following (surgical group) or candidates (nonsurgical group) for bariatric surgery. Demographics, probable COVID-19 incidence, acute and persistent COVID-19 symptoms, and clinical outcome parameters of bariatric patients and candidates for BS were compared. The incidence of probable COVID-19 was assessed including the clinical definition of probable case, according to World Health Organization criteria.

RESULTS

The incidence of probable COVID-19 among surgical and nonsurgical groups was significantly different (20.6% vs 26.08%, respectively, p = 0.046). The probable case of surgical patients had a shorter length of symptoms and hospitalization duration, and a lower proportion of admission in ICUs and hospitals with respect to nonsurgical patients (p < 0.001). Surgical patients had a greater prevalence of persistent symptoms including anorexia, food intolerance, and anosmia-hyposmia than nonsurgical patients. Moreover, surgical patients with probable COVID-19 had a significantly higher proportion of diabetic patients than surgical patients without probable COVID-19 (20% vs 9.3%).

CONCLUSION

These findings highlight the need to evaluate the persistent symptoms of COVID-19 and the importance of nutritional support for at least several weeks after COVID-19 symptom onset. Moreover, it seems that COVID-19 incidence in post-bariatric surgery patients could reduce the effectiveness of bariatric surgery in the resolution of diabetes.

Effects of 6 Months of Soy-Enriched High Protein Compared to Eucaloric Low Protein Snack Replacement on Appetite, Dietary Intake, and Body Composition in Normal-Weight Obese Women: A Randomized Controlled Trial

(1) Background: The favorable effects of high protein snacks on body composition and appetite status in lean and athletic populations have been illustrated previously. However, the effects of soy-enriched high protein snacks have not been investigated in women with normal-weight obesity (NWO). Consequently, we aimed at comparing the effects of six months of soy-enriched high protein snack replacement on appetite, body composition, and dietary intake in women with NWO. (2) Methods: One hundred seven (107) women with NWO [(age: 24 ± 3 yrs, BMI: 22.7 ± 2.3 kg/m², body fat percentage (BFP): 38 ± 3.2%)] who were assigned to one of two groups; high protein snack (HP, n = 52) containing 50 g soybean or isocaloric low-protein snack (protein: 18.2 g, carbohydrate: 15 g, fat: 10 g, energy: 210 kcal) or isocaloric low protein snack (LP, n = 55) containing 3.5 servings of fruit (protein: <2 g, carbohydrate: ≈50 g, fat: <1 g, energy: ≈210 kcal) as part of their daily meals (as a snack at 10 a.m.), successfully completed the study interventions. Body mass (BM), body mass index (BMI), waist circumference (WC), BFP, skeletal muscle mass, dietary intake, and appetite levels were evaluated prior to and after the six-month intervention. (3) Results: Appetite (HP = -12 mm and LP = -0.6 mm), energy intake (HP = -166.2 kcal/day and LP = 91.3 kcal), carbohydrate intake (HP = -58.4 g/day and LP = 6.4 g/day), WC (HP = -4.3 cm and LP = -0.9 cm), and BFP (HP = -3.7% and LP = -0.9%) were significantly (p < 0.05) reduced, while skeletal muscle mass (HP = 1.2 kg and LP = 0.3 kg) significantly increased in the HP compared to the LP group, respectively. (4) Conclusions: Six months of a soy-enriched high protein snack replacement decreased appetite and improved body composition in women with NWO. Our findings suggest that soy-enriched high protein snacks are an efficacious strategy for body composition improvement.

How Does Fat Mass Change in the First Year After Bariatric Surgery? A Systemic Review and Meta-Analysis

This systematic review and meta-analysis investigated the time-course effect of different type of bariatric surgeries (BS) up to 1 year post-surgery on fat mass (FM) and body fat percentage (BFP) in patients with morbid obesity. We searched PubMed, Scopus, EMBASE, ISI web of science, and Cochrane databases from October 2002 until May 2020 with no restriction in the English language, to find studies examining the effect of BS on FM (kg) and BFP (%) in morbid obese patients. Meta-analysis of 103 studies carried out on data of 18,166 and 14,575 morbid obese patients following BS, showed that BS was associated with a substantial decrease in FM and BFP, respectively, in 1 month (- 8.17 kg [95% CI - 9.07, - 7.27] and - 1.51% [95% CI - 2.56, - 0.46]), 3 months (- 15.75 [95% CI - 17.49, - 14.0] and - 4.90 [95% CI - 5.97, - 3.83]), 6 months (- 22.51 [95% CI - 23.93, - 21.09] and - 8.56% [95% CI - 9.63, - 7.49]), and 12 months (- 29.69 [95% CI - 31.3, - 28.09] and - 13.49% [95% CI - 14.52, - 12.40]) after the surgery. In conclusion, BS was associated with sustained declines in FM and BFP, from 1 to 12 months, with no indication of plateau phase post-surgery post-operatively. The present study emphasizes that post-bariatric care should have more focus on FM loss during 1-year post-surgery to identify the patients at risk for fat loss plateau.

A 16-year prospective cohort study to evaluate effects of long-term fluctuations in obesity indices of prediabetics on the incidence of future diabetes

This study aimed to evaluate the patterns of changes in obesity indices over time in prediabetic subjects and to classify these subjects as either having a low, moderate, and high risk for developing diabetes in the future. This study was conducted among 1228 prediabetics. The patterns of changes in obesity indices based on three measurements including first, mean values during the follow-up period, and last visit from these indices were evaluated by using the latent Markov model (LMM). The mean (standard deviation) age of subjects was 44.0 (6.8) years and 73.6% of them were female. LMM identified three latent states of subjects in terms of change in all anthropometric indices: a low, moderate, and high tendency to progress diabetes with the state sizes (29%, 45%, and 26%), respectively. LMM showed that the probability of transitioning from a low to a moderate tendency to progress diabetes was higher than the other transition probabilities. Based on a long-term evaluation of patterns of changes in obesity indices, our results reemphasized the values of all five obesity indices in clinical settings for identifying high-risk prediabetic subjects for developing diabetes in future and the need for more effective obesity prevention strategies.

Maculopapular Exanthema After the Second Dose of Evolocumab

Evolocumab is a relatively new monoclonal antibody designed to decrease low-density lipoproteins via the inhibition of proprotein convertase subtilisin/kexin type 9 (PCSK9). It is used alone or in combination with other lipid-lowering agents. Evolocumab was associated with adverse events of skin rashes in clinical trials. We describe a rare case of maculopapular exanthema in a female patient with hyperlipidemia, which was treated with evolocumab. The patient was a 60-year-old female with hyperlipidemia who experienced a maculopapular rash after she was administered the second dose of evolocumab subcutaneously. The rash occurred on her torso and upper extremities and was associated with pruritus and mild wheezing. The hypersensitivity reaction was treated with antihistamines and with the discontinuation of evolocumab. The skin eruption cleared within 10 days. In conclusion, medical professionals should be aware of evolocumab skin hypersensitivity reactions, which could demand the cessation of the evolocumab treatment.

Alleviating neuropathy of diabetic foot ulcer by co-delivery of venlafaxine and matrix metalloproteinase drug-loaded cellulose nanofiber sheets: production, in vitro characterization and clinical trial

BACKGROUND

The objective of the present study was co-delivery of venlafaxin (VEN) and doxycycline (DOX), a matrix metalloproteinase inhibitor drug, for alleviating inflammation and neuropathy in diabetic foot ulcer (DFU).

METHODS

Bacterial cellulose nanofiber sheets (BCNS) were loaded with DOX and VEN and categorized by their loading efficiency, release profiles and ex vivo permeation throughrat skin. The optimized nanofibers were used in patients with DFU to compare with the standard wound care regimen during a 12-week trial. Wound area was measured every 2 weeks. Biochemical parameters and microscopic studies of the skin were examined prior and at the end of the treatment. The Michigan Neuropathy Screening Instrument (MNSI) questionnaire was utilized to assess diabetic neuropathy.

RESULTS

The optimum formulation showed loading efficiency of 37.8 ± 1.6% for DOX and 48 ± 1.9% for VEN. Rat skin permeation was 40% for DOX after 7-29 h and 83% for VEN during 105 h. Patients treated with BCNS showed no significant difference in their biochemical parameters before and after intervention. The ulcer size showed faster reduction after 12 weeks in the treatment group compared to the control group. The abnormal responses in the MNSI questionnaire decreased and pain-free walking distance increased significantly in the treatment group compared with the control group (p < 0.001). Microscopic studies of the skin after using nanofibers showed a large number of polymorphonuclear chronic inflammatory cells and formation of new capillary beds.

CONCLUSIONS

The BCNS loaded with DOX and VEN may expedite healing and reduce neuropathy in the DFU of diabetic patients.

Esophageal perforation during laparoscopic sleeve gastrectomy: Complication of bougie insertion

INTRODUCTION AND IMPORTANCE

Esophageal perforation (EF) is an uncommon complication of bariatric procedures, mostly related to the intraoperative use of bougie that is used for gastric calibration.

CASE PRESENTATION

Here, we present a 33-year-old woman who underwent laparoscopy sleeve surgery (LSG). Due to perforation in the cervical site of the esophagus caused by bougie insertion, she developed subcutaneous emphysema on the first post-operative day. She immediately underwent reconstructive esophageal surgery under the probable diagnosis of having a cervical esophagus perforation. The patient's condition was stable in the postoperative period and discharged after 10 days.

CLINICAL DISCUSSION

The patients who present symptoms including subcutaneous emphysema, cervical pain, dysphagia, dysphonia, and fever post-surgery have to be considered for probably EF. The early optimal diagnosis works up and therapeutic approach should be performed as soon as possible to prevent mortality.

CONCLUSION

EP caused by a bougie insertion is an uncommon complication that is associated with high mortality rates if the diagnosis and treatment were delayed. The risk of using a bougie during surgery should not be underestimated and have to be inserted with extreme caution and careful guide of surgeon.

Patterns of changes in fasting plasma glucose, hemoglobin A1c and the area under the curve during oral glucose tolerance tests in prediabetic subjects: results from a 16-year prospective cohort study among first-degree relatives of type 2 diabetic patients

AIM

This study aimed to identify the patterns of changes in glycemic indices over time in prediabetics and to classify these subjects as either having a high or low risk for developing diabetes in future.

METHODS

This prospective 16-year cohort study was conducted among 1228 prediabetic subjects. Three measurements including first visit, mean values during the follow-up period, and last visit from fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1_C), and area under the curve during an oral glucose tolerance test (OGTT AUC) were used to evaluate the patterns of changes by using the latent Markov model (LMM).

RESULTS

The mean (standard deviation) age of subjects was 44.0 (6.8) years, and 73.6% of them were female. The LMM identified 2 latent states of subjects in terms of changes in FPG, HbA1c, OGTT AUC, and the combination of these glycemic measures: a low tendency to progress diabetes and a high tendency to progress diabetes with the latent state sizes (87, 13%), (94, 6%), (57, 43%), and (84, 16%), respectively. The LMM showed that the probability of transitioning from a low tendency to a high tendency to progress diabetes was higher than the probability of transitioning in the opposite direction.

CONCLUSION

Based on a long-term evaluation of patterns of changes in glycemic indices, we classified prediabetic subjects into 2 groups (high or low risk to progress diabetes states in future). Also, the method used enabled us to estimate the transition probabilities from low- to high-risk states and vice versa. Our results reemphasized the values of all 3 glycemic measures in clinical settings for identifying prediabetic people with a high risk of progressing diabetes and the need for more effective prevention strategies, which should be conducted as urgently in prediabetic life as high-risk subjects.

Long-term effect of bariatric surgery on body composition in patients with morbid obesity: A systematic review and meta-analysis

We performed a meta-analysis to provide quantitative estimates of fat mass (FM) and fat-free mass (FFM) changes in patients following bariatric surgery over 1 year. A systematic search of PubMed, SCOPUS and Web of Science databases was conducted; the pooled weighted mean difference (WMD) and 95% confidence intervals (CI) were calculated using a random-effects model. Thirty-four studies including Roux en-Y gastric bypass (RYGB), sleeve gastrectomy (SG) biliopancreatic diversion (BPD) and gastric banding (GB) were analyzed. RYGB decreased in body FM (-28.99 kg [31.21, -26.77]) or FM% (-12.73% [-15.14, -10.32]) or FFM (-9.97 kg [-10.93, -9.03]), which were greater than SG and GB. Moreover, the FFM% in RYGB group (11.72% [7.33, 16.11]) was more than SG (5.7% [4.44, 6.95]) and GB (8.1% [6.15, 10.05]) groups. Bariatric surgeries, especially RYGB, might be effective for a decrease in FM and maintenance of FFM in patients with morbid obesity in over 1 year.

Patterns of changes in serum lipid profiles in prediabetic subjects: results from a 16-year prospective cohort study among first-degree relatives of type 2 diabetic patients

Background

Lipid abnormality pervasively is associated with the risk of type 2 diabetes mellitus. To the best of our knowledge, there is no study that has examined the longitudinal changes in a wide range of serum lipid profiles in prediabetic subjects in association with the risk of developing type 2 diabetes mellitus in the future. This study aimed to identify the patterns of changes in lipid profiles over time in prediabetic patients and to classify these subjects in order to highlight which patients are at high risk for future diabetes.

Methods

This prospective 16-year (2003–2019) cohort study was conducted among 1228 prediabetic subjects. The study subjects were followed, and the changes in their lipid profiles, including triglycerides, cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol, were evaluated. The latent Markov model was used for data analysis.

Results

The mean (standard deviation) age of subjects was 44.0 (6.8) years, and 73.6% of them were female. The latent Markov model identified two latent states of subjects in terms of changes in lipid profiles: a low tendency to progress diabetes / high tendency to progress diabetes (74, 26%). The latent Markov model showed that the transition probability from a “low tendency to progress diabetic” state to a “high tendency to progress diabetic” state was lower than the transition probability from “high tendency to progress diabetic” state to “low tendency to progress diabetic” state.

Conclusions

The present study showed that more than half of the first-degree relatives of T2DM had approximately normal lipid profiles and that these patients are more inclined to transition from a higher- to a lower-tendency diabetic state. These findings confirm the value of regular screening of first-degree relatives of T2DM. Moreover, preventive intervention strategies are recommended to reduce their risk of developing T2DM.

Prevalence and predictors of prediabetes and its coexistence with high blood pressure in first-degree relatives of patients with type 2 diabetes: A 9-year cohort study

Background:

Prediabetes is strongly associated with high blood pressure; however, a little is known about prediabetes and high blood pressure comorbidity in the high-risk individuals. This is the first study in the world to assess the long-term effects of risk factors associated with high blood pressure and prediabetes comorbidity in the first-degree relatives (FDRs) of type 2 diabetes mellitus (T2DM) patients.

Materials and Methods:

The longitudinal data obtained from 1388 nondiabetic FDRs of T2DM patients with at least two visits between 2003 and 2011. We used univariate and bivariate mixed-effects logistic regressions with a Bayesian approach to identify longitudinal predictors of high blood pressure and prediabetes separately and simultaneously.

Results:

The baseline prevalence of high blood pressure, prediabetes, and the coexistence of both was 27.4%, 19.1%, and 29.8%, respectively. The risks of high blood pressure and prediabetes were increased by one-unit raise in the age (odds ratio [OR] of high blood pressure: 1.419 (95% credible intervals [CI], 1.077–1.877), prediabetes: 1.055 (95% CI: 1.040–1.068)) and one-unit raise in remnant-cholesterol (OR of high blood pressure: 1.093 (95%CI, 1.067–1.121), and prediabetes: 1.086 (95% CI, 1.043–1.119)). Obese participants were more likely to have high blood pressure (OR: 2.443 [95% CI, 1.978–3.031]) and prediabetes (OR: 1.399 [95% CI, 1.129–1.730]) than other participants.

Conclusion:

We have introduced remnant-cholesterol, along with obesity and age, as a significant predictor of prediabetes, high blood pressure, and the coexistence of both in the FDRs of diabetic patients. Obesity index and remnant-cholesterol showed the stronger effects on high blood pressure and prediabetes comorbidity than on each condition separately.

The effects of 6 mo of supplementation with probiotics and synbiotics on gut microbiota in the adults with prediabetes: A double blind randomized clinical trial

OBJECTIVES

The evidence of 16S rRNA genes in the gut microbiota distinguished a higher Firmicutes-to-Bacteroidetes ratio in individuals who were obese and had diabetes than in a healthy cohort. So, it seems that the modulation of intestinal microbial ecology by pro-/pre-/synbiotics may contribute to the progression and prevention of metabolic diseases. The aim of this study was to assess the effects of probiotics and synbiotic supplementation on the modification of the intestinal microbiome in adults with prediabetes.

METHODS

In a randomized, double-blinded, placebo-controlled clinical trial, 120 patients with prediabetes were randomly assigned to consume 6 g/d of either a placebo containing maltodextrin (control) or multispecies probiotic or inulin-based synbiotic for 6 mo. Fecal samples were obtained at baseline and after 6 mo of supplementation. Dietary intake was assessed throughout the study (at baseline and after 3 and 6 mo). Total energy, macronutrients, and dietary fiber were calculated using a dietary program Nutritionist 4. DNA was extracted from fecal samples and the numbers of Clostridium perfringens (the represent of phylum Firmicutes), Bacteroides fragilis (the representative of Bacteroidetes) and Escherichia coli (as universal bacteria) were determined by quantitative real-time polymerase chain reactions (qPCR). The changes in the relative abundance of the two fecal bacteria before and after supplementation were analyzed and compared within and between groups.

RESULTS

There were no significant changes in dietary intake during the study. Six mo of supplementation with probiotics resulted in a statistically significant increase in the abundance of the B. fragilis-to-E.coli ratio (mean difference [MD] ± SE 0.47 ± 0.37, P = 0.04) and decrease of the relative proportion of Firmicutes-to-Bacteroidetes representatives (MD ± SE -118.8 ± 114.6, P = 0.02). Synbiotic had no significant effect on the changes in the bacteria. There were no significant differences between the three groups.

CONCLUSION

The results of this study suggest that manipulation of the human gut microbiome by using probiotics could provide a potential therapeutic approach in the prevention and management of obesity and metabolic disorders such as diabetes.

Severity of the metabolic syndrome as a predictor of prediabetes and type 2 diabetes in first degree relatives of type 2 diabetic patients: A 15-year prospective cohort study

BACKGROUND

Type 2 diabetes mellitus (T2DM) has high morbidity and mortality worldwide, therefore there is of paramount importance to identify the risk factors in the populations at risk early in the course of illness. A strong correlation between severity of metabolic syndrome (MetS) and HbA1c, fasting insulin and insulin resistance has been reported. Accordingly, the MetS severity score (or MestS Z-score) can potentially be used to predict the risk of T2DM progression over time.

AIM

To evaluate the association the of MestS Z-score in first degree relatives (FDRs) of T2DM with the risk of prediabetes and type 2 diabetes in future.

METHODS

A prospective open cohort study was conducted between 2003-2018. At baseline, the sample comprised of 1766 FDRs of patients with T2DM who had a normal glucose tolerance test. Relative risk (RR) and 95% confidence interval were calculated based on logistic regression. The receiver-operator characteristic analysis and area under the curve based on MetS Z-score were used to evaluate the risk of prediabetes and diabetes among the FDR population.

RESULTS

Baseline MetS Z-scores were associated with the its latest values (P < 0.0001). Compared with individuals who were T2DM free at the end of follow up, those who developed T2DM had higher MetS Z-score at baseline (P < 0.001). In multivariable logistic regression analyses for every unit elevation in MetS Z-score at the baseline, the RR for developing future T2DM and prediabetes was (RR = 1.94, RR = 3.84), (RR = 1.5, RR = 2.17) in total population and female group, respectively (P < 0.05). The associations remained significant after adjusting the potential confounding variables. A cut off value of 0.97 and 0.94 was defined in the receiver-operator characteristic curve based on the MetS Z-score for differentiating female patients with diabetes and prediabetes from the normal population, respectively.

CONCLUSION

The MetS Z-score was associated with an increased risk of future T2DM. Appropriate interventions at earlier stages for preventing and attenuating MetS effects may be considered as an effective strategy for FDR as at-risk population.

Monitoring the quality of frozen-thawed venous segments using bioimpedance spectroscopy

OBJECTIVE

Storage at temperatures as low as -80 °C and below (cryopreservation) is considered a method for long-term preservation of cells and tissues, and especially blood vessel segments, which are to be used for clinical operations such as transplantation. However, the freezing and thawing processes themselves can induce injuries to the cells and tissue by damaging the structure and consequently functionality of the cryopreserved tissue. In addition, the level of damage is dependent on the rate of cooling and warming used during the freezing-thawing process. Current methods for monitoring the viability and integrity of cells and tissues after going through the freezing-thawing cycle are usually invasive and destructive to the cells and tissues. Therefore, employing monitoring methods which are not destructive to the cryopreserved tissues, such as bioimpedance measurement techniques, is necessary. In this study we aimed to design a bioimpedance measurement setup to detect changes in venous segments after freezing-thawing cycles in a noninvasive manner.

APPROACH

A bioimpedance spectroscopy measurement technique with a two-electrode setup was employed to monitor ovine jugular vein segments after each cycle during a process of seven freezing-thawing cycles.

MAIN RESULTS

The results demonstrated changes in the impedance spectra of the measured venous segments after each freezing-thawing cycle.

SIGNIFICANCE

This indicates that bioimpedance spectroscopy has the potential to be developed into a novel method for non-invasive and non-destructive monitoring of the viability of complex tissue after cryopreservation.

Thyroid volume and nodular and diffuse thyroid diseases by ultrasonography in pregnant women: A case-control study

Background

Currently, it is shown that pregnancy may have an impact on the thyroid that can be leading to pregnancy complications such as abortion, preeclampsia, and preterm delivery. The objective was to compare the thyroid volume, number and characteristics of thyroid nodules, and prevalence of diffuse thyroid diseases in a sample of Iranian pregnant women in the first trimester to nonpregnant women.

Materials and Methods

This case-control study was conducted on 298 pregnant and 290 nonpregnant women. Thyroid volume, maximum diameter of thyroid nodules and prevalence of moderate to highly suspicious thyroid nodules, Hashimoto's appearance and goiter were assessed using thyroid ultrasonography. Antithyroperoxidase (TPO) antibodies were measured if the sonographic features were highly suggested for Hashimoto's thyroiditis.

Results

The mean of total thyroid volume in pregnant and nonpregnant women was 6 and 6.5 ml, respectively (P = 0.053), and the median (interquartile range) was 6.2 and 5.5, respectively. Nodules were observed in 16.4% of pregnant and 16.6% of nonpregnant women (P = 0.845). Hashimoto's thyroiditis was detected in 6.7% of pregnant and 12.4% of nonpregnant women (P = 0.013). Anti-TPO antibodies were detected in 5% of pregnant and 9.3% of nonpregnant women (P = 0.034).

Conclusion

The thyroid volume and nodule characteristics in the first trimester of pregnancy were similar to nonpregnant women. Hashimoto's thyroiditis and anti-TPO antibodies in pregnant women were significantly lower than in nonpregnant women.

Factors associated with progression to pre-diabetes: a recurrent events analysis

AIMS

Pre-diabetes is a strong risk factor for type 2diabetes (T2D). The aim of this study was to explore factors associated with normal glucose maintenance and pre-diabetes prevention or delay.

METHODS

Data of 1016 first-degree relatives of T2D patients were retrieved from the Isfahan Diabetes Prevention Study (IDPS). Association of various variables including nutrients, serum tests and physical activity with the risk of pre-diabetes was assessed using recurrent events approach.

RESULTS

Cumulative incidence of diabetes was 8.17, 9.44, and 4.91% for total sample and individuals with and without pre-diabetes experience in the follow-up. Risk of progression to pre-diabetes was higher in women and older people (p < 0.01). Additionally, BMI and blood pressure had significant association with the risk (p < 0.01) and individuals with higher intake of fat were at higher risk (HR = 2.26; 95% CI 1.66-3.07 for high-intake and HR = 1.52; 95% CI 1.27-1.83 for medium-intake compared to low-intake group). Carbohydrates and protein intake were positively associated with the risk of pre-diabetes with HR = 8.63 per 49 g extra carbohydrates per day and HR = 1.32 per 6 g extra protein per day (p < 0.01). The association was also significant for triglyceride (TG) with 7% risk increase per 1 SD = 1.14 increase in TG level.

CONCLUSION

Despite frequent studies on lifestyle modification for pre-diabetes prevention, less information is available about the role of nutritional components. We observed direct effects for intake of macronutrients including fat, carbohydrates, and protein in first-degree relatives. Further research is warranted to assess these associations in general populations.

LEVEL OF EVIDENCE

Level III: Evidence obtained from a single-center cohort study.

Finite Element Simulation of the Impedance Response of a Vascular Segment as a Function of Changes in Electrode Configuration

Monitoring a biological tissue as a three dimensional (3D) model is of high importance. Both the measurement technique and the measuring electrode play substantial roles in providing accurate 3D measurements. Bioimpedance spectroscopy has proven to be a noninvasive method providing the possibility of monitoring a 3D construct in a real time manner. On the other hand, advances in electrode fabrication has made it possible to use flexible electrodes with different configurations, which makes 3D measurements possible. However, designing an experimental measurement set-up for monitoring a 3D construct can be costly and time consuming and would require many tissue models. Finite element modeling methods provide a simple alternative for studying the performance of the electrode and the measurement set-up before starting with the experimental measurements. Therefore, in this study we employed the COMSOL Multiphysics finite element modeling method for simulating the effects of changing the electrode configuration on the impedance spectroscopy measurements of a venous segment. For this purpose, the simulations were performed for models with different electrode configurations. The simulation results provided us with the possibility of finding the optimal electrode configuration including the geometry, number and dimensions of the electrodes, which can be later employed in the experimental measurement set-up.

Probiotic and synbiotic supplementation could improve metabolic syndrome in prediabetic adults: A randomized controlled trial

AIMS

Modulation of the gastrointestinal microbiome is suggested to contribute to the progression of metabolic syndrome associated diseases. This study was designed to assess the effects of probiotics and synbiotics on metabolic syndrome in individuals with prediabetes.

METHODS

120 adults with prediabetes were enrolled in a double-blind, placebo-controlled randomized parallel-group clinical trial. Participants were randomized to a multi-species probiotic or inulin-based synbiotic or placebo. Blood samples and anthropometric measures were collected at baseline, 12 and 24 weeks after treatment. The primary outcome measures were the changes between groups in metabolic syndrome and its components' prevalence.

RESULTS

A significant trend for a reduction in the prevalence of hyperglycemia in probiotic and synbiotic groups (p = 0.01 and 0.005 respectively), and hypertension in probiotic group (p = 0.04) was found. The decreases in metabolic syndrome prevalence were significant after taking probiotic and synbiotic supplementation as compared with placebo (p = 0.02). Also, the prevalence of low HDL-cholesterol level was decreased during the study in the probiotic group compared with placebo (p = 0.02).

CONCLUSIONS

The potential benefits of using probiotic and synbiotic for metabolic syndrome management in prediabetes have been supported by the results in the current study which might provide an important strategy to combat metabolic syndrome-associated diseases.

Effects of probiotics and synbiotic on lipid profiles in adults at risk of type 2 diabetes: A double-blind randomized controlled clinical trial

Background: The use of probiotics and/or prebiotics as an effective means of regulating gut microbiota may have a beneficial effect on metabolic disorders.Aims: This study was designed to assess the ability of probiotics and synbiotic to modify lipid profiles in subjects with prediabetes who are at risk of diabetes and cardiovascular diseases.Methods: In a randomized double-blind placebo-controlled clinical trial, 120 pre-diabetic adults aged 35-70 years from the first-degree family of type 2 diabetic patients were recruited and randomly equally assigned to consume 6 g/d either probiotic or synbiotic or placebo supplements for 6 months. The probiotics used were Lactobacillus acidophilus, Bifidobacterium bifidum, Bifidobacterium lactis, and Bifidobacterium longum. Food record, physical activity, anthropometric measures and lipid profiles were assessed repeatedly at baseline, and 3- and 6-month supplementation.Results: Probiotics and synbiotic were effective in reduction of serum triglycerides after 6 months of intervention (SMD=- 10.6 and -9.4 respectively). Compared with the placebo, synbiotic resulted in a significant reduction in serum triglyceride levels (MD±SE: -9.4 ± 6.6 mg/dl vs. +13.2±6.8 mg/dl, p=0.02). Serum total-, LDL-, and HDL-cholesterol were statistically unaffected by probiotic or synbiotic.Conclusion: The results of this study showed that supplementation with probiotic and especially synbiotic could decrease the concentration of triglyceride in prediabetic adults. This finding could warrant future studies to determine the therapeutic and preventive effects of these supplements in individuals at risk of diabetes and cardiovascular diseases.Keywords: probiotic; synbiotic; prediabetes; lipid; lipoprotein

Cause-Specific Risk Factors of Death in Individuals with Diabetes: A Competing Risks Modeling

BACKGROUND

Diabetes is on the rise worldwide.

OBJECTIVES

This study aimed to evaluate the risk factors of various causes of death in people with type 2 diabetes (T2D).

METHODS

In this cohort study on 2638 people with T2D, we applied cause-specific and sub-distribution hazards models to assess the impact of various factors on the risk of death. Moreover, we plotted a cumulative incidence curve to summarize cumulative failure rates over time.

RESULTS

About 75% of individuals with T2D died from cardiovascular disease (CVD) and cerebrovascular accidents (CVA). Death from CVD was associated with the increased risk of hypertension (hazard ratio (HR) = 1.83, 95% CI: 1.37 - 2.46), hypercholesterolemia (HR = 1.58, 95% CI: 1.17 - 2.14), and diabetes duration. The risk of death from CVA was related to hypertension (HR = 2.76, 95% CI: 1.67 - 4.55) and hyperglycemia (HR = 4.34, 95% CI: 1.75 - 10.79). The CVA risk in patients with diabetes duration of 10 - 20 years was higher than the risk in patients with diabetes duration > 20 years (diabetes duration of ≤ 10 years as the reference category). Diabetes duration of longer than 20 years was associated with a higher risk of death from cancer (HR = 2.65, 95% CI: 1.05 - 6.68). The risk of death from foot infection and diabetic nephropathy increased in patients with longer diabetes duration after adjustment for sex, age, and body mass index.

CONCLUSIONS

Regardless of the cause, death rates in people with T2D increase over time and risk factors have different impacts on death from each cause. This should be acknowledged in risk management in individuals with T2D.

Different metabolic/obesity phenotypes are differentially associated with development of prediabetes in adults: Results from a 14-year cohort study

BACKGROUND

The risk of developing prediabetes based on the metabolic/obesity phenotypes has been poorly investigated.

AIM

To examine the association of baseline metabolic/obesity phenotypes and their changes over time with the risk of prediabetes development.

METHODS

In a population-based cohort study, 1741 adults (aged > 19 years) with normal blood glucose were followed for 14 years. Anthropometric and biochemical measures were evaluated regularly during the follow-up period. According to body mass index and metabolic health status, participants were categorized into four groups: Metabolically healthy normal weight (MHNW), metabolically healthy obese (MHO), metabolically unhealthy normal weight (MUNW) and metabolically unhealthy obese (MUO). Multivariable Cox regression analysis was used to measure the risk of prediabetes according to the baseline metabolic/obesity phenotype and their changes during the follow-up.

RESULTS

In the whole population with a mean (95CCI for mean) follow up duration of 12.7 years (12.6-12.9), all three MUNW, MHO, MUO groups were at higher risk for developing prediabetes compared to the MHNW group (P = 0.022). The MUNW group had the highest risk for developing prediabetes (hazard ratio (HR): 3.84, 95%CI: 1.20, 12.27). In stratified analysis by sex, no significant association was found in men, while women in the MUNW group were at the greatest risk for prediabetes (HR: 6.74, 95%CI: 1.53, 29.66). Transforming from each phenotype to MHNW or MHO was not related to the risk of prediabetes development, whereas transforming from each phenotype to MUO was associated with an increased risk of prediabetes (HR > 1; P < 0.05).

CONCLUSION

Our findings indicate that MHO is not a high risk, unless it transforms into MUO over time. However, people in the MUNW group have the greatest risk for developing prediabetes, and therefore, they should be screened and treated.

Quantum transport through the edge states of zigzag phosphorene nanoribbons in presence of a single point defect: analytic Green's function method

Zigzag phosphorene nanoribbons have quasi-flat band edge modes entirely detached from bulk states. We analytically study the electronic transport through such edge states in the presence of a localized defect for semi-infinite and finite ribbon widths. Using the tight-binding model, we derive analytical expressions for the Green's function and transmission amplitude of both pristine and defective nanoribbons. We find that the transmission of ribbons with both semi-infinite and finite width is sensitive to the location of a single impurity defect with respect to the edge. By the presence of an impurity on the outermost edge site of the ribbon, the transmission through the edge channel, similar to a one-dimensional chain, strongly suppresses for the entire energy spectrum of the quasi-flat band. In contrast, the transmission of low-energy [Formula: see text] states, is robust as the impurity is moved one position far away from the edge on the same sub-lattice. The analytical calculations are also complemented by exact numerical transport computations using the Landauer approach.

Cross-sectional and longitudinal assessments of risk factors associated with hypertension and moderately increased albuminuria comorbidity in patients with type 2 diabetes: a 9-year open cohort study

BACKGROUND

Moderately increased albuminuria (MIA) is strongly associated with hypertension (HTN) in patients with type 2 diabetic mellitus (T2DM). However, the association between risk factors and coexisting HTN and MIA remains unassessed.

OBJECTIVES

This study aimed to determine both cross-sectional and longitudinal associations of risk factors with HTN and MIA comorbidity in patients with T2DM.

METHODS

A total of 1,600 patients with T2DM were examined at baseline and longitudinal data were obtained from 1,337 T2DM patients with at least 2 follow-up visits to assess the presence of HTN alone (yes/no), MIA alone (yes/no) and the coexistence of both (yes/no) in a 9-year open cohort study between 2004 and 2013. Bivariate mixed-effects logistic regression with a Bayesian approach was employed to evaluate associations of risk factors with HTN and MIA‎ comorbidity in the longitudinal assessment.

RESULTS

After adjustment for age and BMI, patients with uncontrolled plasma glucose, as a combined index of the glucose profile, were more likely to have HTN [odds ratio (OR): 1.73 with 95% Bayesian credible intervals (BCI) 1.29-2.20] and MIA [OR: 1.34 (‎95% BCI 1.13-1.62)]. The risks of having HTN and MIA were increased by a one-year raise in diabetes duration [with 0.89 (95% BCI 0.84-0.96) and 0.81 (95% BCI 0.73-0.92) ORs, respectively] and a one-unit increase in non-high-density lipoprotein-cholesterol (Non-HDL-C) [with 1.30 (95% BCI 1.23-1.34) and 1.24 (95% BCI 1.14-1.33) ORs, respectively].

CONCLUSIONS

T2DM patients with HTN,‎ MIA, and the coexistence of both had uncontrolled plasma glucose, significantly higher Non-HDL-C, and shorter diabetes duration than the other T2DM patients. Duration of diabetes and uncontrolled plasma glucose index showed the stronger effects on HTN and MIA comorbidity than on each condition separately.

The effects of probiotics and synbiotic supplementation on glucose and insulin metabolism in adults with prediabetes: a double-blind randomized clinical trial

AIMS

Probiotics and/or prebiotics could be a promising approach to improve metabolic disorders by favorably modifying the gut microbial composition.

OBJECTIVES

To assess the effects of probiotics and synbiotic on glycemic indices in prediabetic individuals who are at risk of type 2 diabetes and its complications.

METHODS

In a double-blind, randomized, placebo-controlled parallel-group clinical trial, 120 prediabetic adults participated and were randomly allocated to receive either probiotics or synbiotic or placebo supplements for 24 weeks. Anthropometric measurements, food record, physical activity and glycemic biomarkers including glycated hemoglobin (HbA1C), fasting plasma glucose (FPG), fasting insulin levels (FIL), homoeostasis model assessment for insulin resistance (HOMA-IR), quantitative insulin sensitivity check index (QUICKI), and β-cell function (HOMA-B) were assessed at baseline and repeated at 12 and 24 weeks and compared within and between three groups using repeated measure ANOVA.

RESULTS

Compared with the placebo, synbiotic supplementation resulted in a higher significant reduction in FPG (- 6.5 ± 1.6 vs. - 0.82 ± 1.7 mg/dL, P = 0.01), FIL (- 2.6 ± 0.9 vs. - 0.8 ± 0.8 µIU/mL, P = 0.028), and HOMA-IR (- 0.86 ± 0.3 vs. - 0.16 ± 0.25, P = 0.007), and a significant elevation in the QUICKI (+ 0.01 ± 0.003 vs. + 0.003 ± 0.002, P = 0.006). In addition, significant decreases in HbA1C was seen following the supplementation of probiotics and synbiotic compared with the placebo (- 0.12 ± 0.06 and - 0.14 ± 0.05 vs. +0.07 ± 0.06%, P = 0.005 and 0.008, respectively). HOMA-B was not found to be different between or within the three groups.

CONCLUSION

Glycemic improvement by probiotics and particularly synbiotic supplements in prediabetic individuals has been supported by current study. However, further studies are required for optimal recommendations in this important area of patient treatment.

TRIAL REGISTRATION

Iranian Registry of Clinical Trials: IRCT201511032321N2, Date registered February 27, 2016.

Low-density lipoprotein cholesterol and risk of type 2 diabetes: The Isfahan diabetes prevention study

BACKGROUND

Studies reported that lipid-lowering treatment may increase the risk of diabetes, support the hypothesis that low-density lipoprotein cholesterol (LDLC) may be associated with type 2 diabetes (T2D).

OBJECTIVE

The aim of this study was to assess the association between the LDLC levels and the incidence of T2D in an Iranian high-risk population not treated with lipid-lowering medications.

METHODS

Mean 10-year follow-up data (1819) in non-diabetic first-degree relatives (FDR) of consecutive patients with T2D 30-70 years old, who were not treated with lipid-lowering drugs at baseline were examined. The diagnosis of T2D based on serial oral glucose tolerance test was the primary outcome. Cox proportional hazard model was used to estimate the hazard ratio (HR) for the incidence of T2D within tertiles of LDLC.

RESULTS

A higher LDLC concentration was significantly associated with higher risk of T2D. Compared with the first tertile, the adjusted risk of T2D increased for the second (HR 1.20, 95% CI: 1.07, 1.35, P < 0.01) and third (HR 1.22, 95% CI: 1.08, 1.37, P < 0.01), tertiles of LDLC.

CONCLUSIONS

While these results await confirmation, a higher LDLC level was significantly associated with higher risk of T2D, independent of age, gender, fasting plasma glucose, waist circumference or blood pressure, in high-risk individuals in Iran.