Journal of Endocrinology, Metabolism and Diabetes in South Africa - latest Issue
Volume 21, Issue 3, 2016
Source: Journal of Endocrinology, Metabolism and Diabetes in South Africa 21, pp 1 –2 (2016)More Less
The National Osteoporosis Foundation of South Africa (NOFSA) would like to comment on 2 areas of contention namely calcium and vitamin D supplementation and the use of pharmacotherapy to prevent fractures. These controversies are fundamentally based on 2 papers by Järvinin and Greg & Bollard. There have been several published responses to these articles by respected sources such as the International Osteoporosis Foundation (IOF) available on the NOFSA website www.osteoporosis.org), which allow the reader to formulate a balanced opinion. For the sake of scientific balance, we will address several key points raised in these papers.
Author Jeff WingSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 21, pp 4 –4 (2016)More Less
It certainly has been a tumultuous year with international and national events indicating major changes occurring on both the global and South African landscapes. History is a retrospective discipline and tends to produce less precise data (a scientific no no). However, we can anticipate that p-values currently being generated are likely to be cited as highly significant in the history analogues of the future. So let us revert back to more precise science and to our smaller and reassuring world of contemporary endocrinology research.
Relationship between MPV and paraoxonase-1 activity, brachial artery diameter and IMT in patients with diabetes mellitusSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 21, pp 40 –46 (2016) http://dx.doi.org/10.1080/16089677.2016.1212964More Less
Aims: Higher mean platelet volume (MPV) in diabetic patients has been considered as an emerging risk factor for diabetes related micro- and macrovascular complications. Human paraoxonase 1/arylesterase (PON1), which has antioxidant and antiatherogenic properties, is documented in high oxidative stress conditions like uncontrolled diabetes. The present study aimed to evaluate the relationship between mean platelet volume (MPV) and paraoxonase-1 (PON-1) activity, brachial artery diameter (BAd) and intima media thickness (BA-IMT), in diabetic patients with regard to obesity and diabetic complications.
Methods: Two-hundred and one diabetic patients (mean age: 52.4 ± 13.4 years, 73.6% females) were grouped according to obesity and diabetic complications (microvascular and macrovascular). Data on demographics, anthropometrics, diabetic complications, MPV levels, BAd and BA-IMT, and serum paraoxonase and arylesterase activities were recorded. The correlation of MPV values to paraoxonase and arylesterase activities, BAd and BA-IMT was evaluated.
Results: Paraoxonase and arylesterase values were 119.8 ± 37.5 U/L and 149.0 ± 39.9 U/L, respectively, with no significant difference in respect of obesity and macrovascular complications. Significantly lower values for paraoxonase (107.5 ± 30.7 vs. 123.9 ± 38.8 U/L, p = 0.007) and arylesterase (132.1 ± 30.2 vs. 154.7 ± 41.2, U/L, p = 0.001) were noted in patients with microvascular complications. MPV values were 9.10 ± 0.87 fL, with no significant difference across the groups and no significant correlation with other parameters.
Conclusion: In conclusion, PON-1 activity is more significantly decreased in diabetic patients with microvascular than macrovascular complications with no effects on MPV values. On the other hand, no relationship was found between thrombogenic activity and PON-1 activity, BAd and BA-IMT regardless of obesity and diabetic complications.
Latest diagnostic approaches to determine the cause of ACTH-dependent Cushing’s syndrome, in the South African settingSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 21, pp 47 –50 (2016) http://dx.doi.org/10.1080/16089677.2016.1212965More Less
A case of a 50-year-old woman who was referred for the evaluation of possible ACTH-dependent Cushing’s syndrome (CS) is described. The localisation of ACTH-dependent CS remains difficult despite many advances in diagnostic approaches. No single test can accurately determine the location of ACTH excess and therefore a combination of non-invasive imaging, stimulation and suppression tests are advised. The recent advances, current utility and pitfalls of each of these tests are reviewed. If non-invasive tests fail to confidently localise the source of ACTH excess, inferior petrosal sinus sampling (IPSS) should follow. Recent advances improving the diagnostic accuracy of IPSS, such as DDAVP stimulation and simultaneous sampling for prolactin is discussed. Where ectopic ACTH production is suspected, newer nuclear medicine techniques, such as somatostatin receptor imaging that recently became available in South Africa, can be utilised. The role of nuclear medicine imaging in identifying ectopic ACTH production is discussed briefly.
Source: Journal of Endocrinology, Metabolism and Diabetes in South Africa 21, pp 51 –55 (2016) http://dx.doi.org/10.1080/16089677.2016.1228745More Less
Objective: The objective of this study was to compare the effect of adjuvant lithium therapy on the efficacy of radioactive iodine therapy in hyperthyroidism.
Methods: This was a prospective simple randomised comparative, experimental cohort study of hyperthyroid patients for radioactive iodine (RAI) ablation therapy. A total of 163 of the 185 hyperthyroid patients recruited completed the study. Cure was defined by achievement of euthyroidism or hypothyroidism.
Results: From of total of 163 patients, 75 received RAI alone and 88 received RAI with lithium. Those who received RAI with adjuvant lithium showed a higher cure rate (78.4%) compared with those who received RAI only (68.1%) (p = 0.002). At one month post RAI therapy, 27.4% of patients who received RAI with adjuvant therapy were cured. This finding showed a trend of being significant compared with just 14.5% cure rate in the group of patients who received RAI alone (p = 0.08). This is an indication of a faster cure rate for patients receiving RAI with lithium. Difference in mean T4 concentration at three months between RAI only (17.67 pmol/l) and RAI with lithium (11.55 pmol/l) was significant with a small size effect (U = 2328.5, Z = –2.700, p = 0.007, r = 0.01). A significant drop in T4 concentrations was observed between the baseline and one-month visit with small effect size (p = 0.001, r = 0.287) in patients who received both RAI and lithium.
Conclusion: Adjuvant lithium therapy increases the efficacy of radioactive iodine treatment in hyperthyroidism by increasing overall cure rate and also shortening the time to cure.
Source: Journal of Endocrinology, Metabolism and Diabetes in South Africa 21, pp 56 –62 (2016) http://dx.doi.org/10.1080/16089677.2016.1240934More Less
Objective: The objective of this study was to determine serum advanced glycation end products (AGEs) levels in black South African patients with and without type 2 diabetes (T2D) and to compare the results with those reported for other ethnic/race groups.
Design: Analytical cross-sectional study.
Setting and subjects: The study subjects consisted of 138 black South African patients with T2D and 81 non-diabetic patients at Dr George Mukhari Academic Hospital in Pretoria, South Africa.
Outcome measures: Serum total AGEs (TAGEs), Nɛ-carboxymethyl-lysine (CML), Nɛ-carboxyethyl-lysine (CEL) and fluorescent AGEs (FAGEs).
Results: Serum TAGEs, CML and CEL levels but not FAGEs were significantly higher in T2D patients than in non-diabetic patients. Serum TAGEs were lower than those reported for other ethnic/race groups whereas CML and FAGEs were within ranges reported for other ethnic/race groups. Only serum CEL levels were significantly higher in male than in female T2D patients and only serum FAGEs levels were negatively associated with age of the study subjects.
Conclusions: With the exception of FAGEs, serum AGEs levels are significantly higher in T2D than in non-diabetic black South Africans patients. Also, serum TAGE levels black South African appear to be lower than those reported for other ethnic/race groups.