Efficacy of a glucose meter connected to a mobile app on glycemic control and adherence to self-care tasks in patients with T1DM and LADA: a parallel-group, open-label, clinical treatment trial

ABSTRACT Objective: The main aim of the study was to evaluate the patients' glycemic control and adherence to self-care tasks. Materials and methods: Patients with type 1 diabetes mellitus (T1DM) or latent autoimmune diabetes of the adult (LADA) using a multiple daily injection (MDI) regimen with carbohydrate counting (n = 25, Subgroup B) or fixed insulin dose (n = 25, Subgroup C) were allocated to use the application (app) for 12 weeks. Both subgroups were compared with each other and against a control group (n = 25, Group A) comprising patients with T1DM or LADA treated with continuous subcutaneous insulin infusion (CSII) in a parallel-group, open-label, clinical treatment trial. All patients had glycated hemoglobin (A1C) levels measured and were asked to fill out the Diabetes Self-Management Profile (DSMP) questionnaire at study start and end. The patients were instructed to measure capillary glucose six times daily in study weeks 4, 8, and 12. Results: Mean A1C levels decreased 0.725% in Subgroup C in intragroup analysis (p = 0.0063), and had a mean variation of 0.834% compared with Group A (p = 0.003). Mean DSMP scores increased 5.77 points in Subgroup B in intragroup analysis (p = 0.0004) and increased by a mean of 6.815 points in relation to Group A (p = 0.002). Conclusion: OneTouch Reveal improved both A1C levels and DSMP scores in patients with T1DM or LADA compared with standard treatment (CSII).

The impact of minimal extrathyroidal extension in the recurrence of papillary thyroid cancer patients

ABSTRACT Objective We aimed to evaluate the impact of minimal extrathyroidal extension (mETE) alone on the risk of recurrence of papillary thyroid carcinoma (PTC). The impact of other factors, including multifocality, age, tumor size, and stimulated thyroglobulin (sTg) values was also assessed. Subjects and methods We retrospectively analyzed 1,108 PTC patients from a medical institution, who presented tumors ≤ 4 cm without any adverse characteristics other than mETE. Patients were classified according to their response to initial treatment 12 to 24 months after surgery as proposed by the 2015 American Thyroid Association (ATA) guideline. Statistical analysis was performed using multivariate logistic regression and receiver operating characteristic (ROC) curve. Results In the multivariate logistic regression analysis, mETE did not have an impact on the response to initial treatment (p = 0.44), similar to multifocality, age, and tumor size. Initial Tg value was the only variable associated with a poor response (p < 0.01, odds ratio = 1.303, 95% confidence interval 1.25-1.36). The ROC analysis revealed that Tg was significant (area under curve = 0.8750); the cutoff value of sTg as a predictor of poor response was 10 ng/mL (sensitivity = 72.2%, specificity = 98.5%). Conclusion For low-risk PTC presenting mETE as the only aggressive feature, the initial sTg value is essential to identify patients who may have a poor response after initial treatment and benefit from further treatment. Arch Endocrinol Metab. 2020;64(3):251-6

Úlceras gastroduodenais como manifestação clínica de histoplasmose disseminada em paciente com vírus da imunodeficiência humana positivo: relato de caso / Progressive disseminated histoplasmosis presenting as gastroduodenal ulcers in a human immunodeficiency virus patient: case report

JUSTIFICATIVA E OBJETIVOS: A histoplasmose é uma doença fúngica causada pelo Histoplasma capsulatum. É rara em imunocompetentes;no entanto, em pacientes imunossuprimidos, a infecção ocorre de forma disseminada e grave, podendo acometer vários órgãos, incluindo o trato gastrintestinal. O objetivo deste estudo foi relatar o caso de uma apresentação incomum de infecção pelo H. capsulatum, alertando os clínicos quanto à inclusão da histoplasmose no diagnóstico diferencial de úlceras gastrintestinais, principalmente no paciente imunocomprometido. RELATO DO CASO: Paciente do sexo masculino, 45 anos,portador de síndrome da imunodeficiência adquirida (SIDA),com perda de peso, febre, sudorese noturna, adenomegalias cervicais e sangramento gastrintestinal. A radiografia de tórax mostrou infiltrado intersticial bilateral difuso, e a tomografia computadorizada (TC) de abdômen mostrou hepatomegalia e adenomegalias intra-abdominais. Na endoscopia digestiva alta foram encontradas úlceras no estômago e duodeno. O exame anatomopatológico das lesões foi compatível com histoplasmose do trato gastrintestinal. CONCLUSÃO: É de extrema importância o diagnóstico diferencial de úlceras gastrintestinais, principalmente em pacientes imunossuprimidos, uma vez que diversas doenças que assim se manifestam se não tratadas adequadamente, têm evolução fatal.

BACKGROUND AND OBJECTIVES: Histoplasmosis is afungal disease caused by Histoplasma capsulatum. It rarely occurs in immunocompetent individuals; however, in immunocompromised patients, the infection is usually severe and disseminated. Many organs can be affected, including the gastrointestinal tract.The objective of this study is to report an uncommon presentation of histoplasmosis, showing that the differential diagnosis of gastrointestinal ulcers is of great importance, particularly in the immunocompromised patient. CASE REPORT: Male patient, 45-year-old, immunodeficiency virus human-positive, was admitted to the hospital presenting with weight loss, night sweats, fever, cervical adenomegalies and gastrointestinal bleeding. Chest radiography showed diffuse interstitial pulmonary infiltrates bilaterally; computerized tomography of the abdomen showed hepatomegaly and intraabdominal adenomegalies. Upper gastrointestinal endoscopy revealed gastric and duodenal ulcers. The pathologic examination of the ulcerswas consistent with gastrointestinal histoplasmosis. CONCLUSION: Reassures the need for the differential diagnosis of gastrointestinal ulcers, particularly in immunosuppressed patients, since many diseases that present this way, have fatal outcomeif not treated properly.