scholarly journals 11-Oxygenated C19 Steroids Do Not Distinguish the Hyperandrogenic Phenotype of PCOS Daughters from Girls with Obesity

2020 ◽  
Vol 105 (11) ◽  
Author(s):  
Laura C Torchen ◽  
Ryan Sisk ◽  
Richard S Legro ◽  
Adina F Turcu ◽  
Richard J Auchus ◽  
...  
Keyword(s):  
Polycystic Ovary ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tanner Stage ◽  
Sex Hormone Binding Globulin ◽  
Ovary Syndrome ◽  
Lean Control ◽  
Academic Medical ◽  
Steroid Profiles ◽  
History Of

Abstract Context Hyperandrogenemia (HA) is a consistent reproductive phenotype in women with polycystic ovary syndrome (PCOS) and their relatives. Increased testosterone levels are present in premenarchal daughters of affected women (PCOS-d). Obese girls (OB-g) without a family history of PCOS also have peripubertal HA. The sources and significance of HA in these groups remains unknown. Objective 11-oxygenated 19-carbon (C19) steroids are adrenally derived androgens that are elevated in hyperandrogenic disorders, including PCOS. We performed this study to test the hypothesis that peripheral serum 11-oxygenated steroids would differ in PCOS-d compared with OB-g suggesting distinct etiologies of HA in affected girls. Design, Setting, and Participants We compared peripheral serum 11-oxygenated steroid levels in 21 PCOS-d, 29 OB-g, and 17 lean control girls (LC) of comparable age at an academic medical center. Results Body mass index (BMI) differed by design (P < 0.001). 11β-hydroxyandrostenedione, 11-ketoandrostenedione, and 11β-hydroxytestosterone levels did not differ between the groups. Compared with LC, PCOS-d and OB-g had similar elevations in 11-ketotestosterone (11KT) (analysis of variance [ANOVA] P = 0.03; PCOS-d vs LC, P = 0.04; OB-g vs LC, P = 0.05; PCOS-d vs OB-g, P = 0.97). In multivariate regression, 11KT levels were associated with DHEAS (P = 0.008), but not with BMI z score, breast Tanner stage, testosterone, anti-Müllerian hormone or sex hormone–binding globulin levels. Conclusions Circulating 11KT levels were similarly elevated in peripubertal PCOS-d and OB-g, suggesting an adrenal component of HA in both groups. We found that 11-oxygenated 19-carbon steroid profiles did not identify subtypes of HA girls.

Factors Related to Complications Among Adult Patients With Intellectual Disabilities Hospitalized at an Academic Medical Center

2015 ◽  
Vol 53 (2) ◽  
pp. 114-119 ◽  
Author(s):  
Sarah H. Ailey ◽  
Tricia J. Johnson ◽  
Louis Fogg ◽  
Tanya R. Friese
Keyword(s):  
Intellectual Disabilities ◽  
Medical Center ◽  
Academic Medical Center ◽  
Autism Spectrum ◽  
Adult Patients ◽  
Respiratory Disorder ◽  
Academic Medical ◽  
History Of ◽  
Healthcare Acquired Infections ◽  
Improve Hospital

Abstract People with intellectual disabilities (ID) represent a small but important group of hospitalized patients who have higher rates of complications than do patients without ID hospitalized for the same reasons. Complications are potentially avoidable conditions, such as healthcare-acquired infections, healthcare-acquired skin breakdown, falls, and medication errors and reactions. Addressing factors related to complications can focus efforts to improve hospital care. The purpose of this exploratory study was to analyze data from reviews of academic medical center charts (N  =  70) about complications and to examine patient and hospitalization characteristics in relation to complications among adult patients (age ≥ 18 years) with ID hospitalized for nonpsychiatric reasons. Adults with ID tended to be twice as likely to have complications (χ2  =  2.893, df  =  1, p  =  .09) if they had a surgical procedure and were nearly four times as likely to have complications (χ2  =  6.836, df  =  1, p  =  .009) if they had multiple chronic health conditions (three of the following: history of cerebral palsy, autism spectrum symptoms, aggressive behavior, respiratory disorder, and admission through the emergency department). Findings suggest preliminary criteria for assessing risk for complications among hospitalized people with ID and the need for attention to their specific needs when hospitalized.

scholarly journals Independent risk factors for chronic illicit substance use during pregnancy

2020 ◽  
Vol 16 (5) ◽  
pp. 351-356
Author(s):  
Manuel C. Vallejo, MD, DMD ◽  
Robert E. Shapiro, MD ◽  
Mitchell W. Lippy, BS ◽  
Christa L. Lilly, PhD ◽  
Leo R. Brancazio, MD
Keyword(s):  
Substance Use ◽  
Alcohol Use ◽  
Medical Center ◽  
Academic Medical Center ◽  
Illicit Substance ◽  
Illicit Substance Use ◽  
Academic Medical ◽  
Multiple Variable ◽  
History Of ◽  
Independent Risk Factors

Objective: We aimed to determine the incidence of chronic illicit substance use during pregnancy and to identify associated risk factors.Design: A 2-year time-matched retrospective maternal quality control database (n = 4,470) analysis of parturients with chronic illicit substance use compared to controls.Setting: A tertiary academic medical center located in a rural setting.Results: The rate of chronic illicit substance use was 1.95 percent. Demographic factors associated with chronic illicit substance use in pregnancy-included lower body mass index (BMI; OR: 0.93; 95 percent CI: 0.89-0.96, p 0.0001), higher gravidity (OR: 1.24; 95 percent CI: 1.13-1.36, p 0.0001), higher parity (OR: 1.38; 95 percent CI: 1.22-1.57, p 0.0001), and more live births (OR: 1.30; 95 percent CI: 1.16-1.46, p 0.0001). A history of smoking (OR: 10.51; 95 percent CI: 5.69-19.42, p 0.0001), alcohol use (OR: 48.98; 95 percent CI: 17.33-138.40, p 0.0001), anxiety (OR: 1.88; 95 percent CI: 1.16-3.05, p = 0.01), depression (OR: 2.44; 95 percent CI: 1.55-3.85, p = 0.0001), transfer on admission (OR: 2.12; 95 percent CI: 1.16-3.87, p = 0.01), payor insurance (OR: 2.12, 95 percent CI: 2.10-5.04, p 0.0001), and Apgar scores 7 at 1 minute (OR: 0.50; 95 percent CI: 0.25-1.00, p = 0.049) were significant. Multiple variable logistic regression-revealed BMI, smoking, alcohol use, and Apgar score 7 at 1 minute as significant factors.Conclusions: Awareness of these factors can assist in identifying and treating parturients with chronic illicit substance use.

scholarly journals The Prescribing and Education of Naloxone in a Large Academic Medical Center

Pharmacy ◽  
2020 ◽  
Vol 8 (1) ◽  
pp. 31
Author(s):  
Sabrina Miller ◽  
Lauren Williams ◽  
Amy N. Thompson
Keyword(s):  
Medical Center ◽  
Demographic Data ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
Reversal Agents ◽  
Outpatient Prescription ◽  
Current State ◽  
Academic Medical ◽  
History Of ◽  
Improvement Measures

The opioid epidemic has led to increased needs for opioid reversal agents which require education and counseling for proper use. The purpose of this study was to evaluate outpatient naloxone prescribing and education practices at an academic medical center to understand the current state and inform quality improvement measures. This retrospective chart review study included 439 patients that were at least 18 years old and received an outpatient prescription for naloxone between 1 July 2017 and 30 June 2018. Descriptive and demographic data were collected. The primary endpoint was whether an indication for naloxone and education on administration were documented when naloxone was initially prescribed to patients. Overall, 39% of naloxone prescriptions did not have an indication for prescribing listed in the medical record. Of those with a documented indication, concomitant benzodiazepines and history of overdose or substance abuse were most common (22% and 14%). The average morphine milligram equivalents were 165. Additionally, 69% of dispenses did not have documentation that the patient or a caregiver received education regarding the use and administration of naloxone. These findings suggest that patients are receiving naloxone for appropriate indications. Documentation of medication education is needed to ensure it is occurring and that patients are informed.

scholarly journals Otolaryngologists and the Early Diagnosis of Mucopolysaccharidoses: A Cross-Sectional Study

Diagnostics ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. 187 ◽  
Author(s):  
Danielle de Araujo Torres ◽  
Anneliese Lopes Barth ◽  
Mariana Pires de Mello Valente ◽  
Paulo Pires de Mello ◽  
Dafne Dain Gandelman Horovitz
Keyword(s):  
Chart Review ◽  
Medical Center ◽  
Academic Medical Center ◽  
Cross Sectional Study ◽  
Inborn Errors ◽  
Cross Sectional ◽  
Academic Medical ◽  
Fatal Course ◽  
History Of ◽  
Nose And Throat

Mucopolysaccharidoses (MPS) are a group of inborn errors of metabolism with an aggressive and usually fatal course. Therefore, early treatment is essential because the involvement of head and neck structures is almost always present in MPS. Our study aimed to retrospectively assess—via a chart review and a survey of caregivers—the history of ear, nose and throat (ENT) symptoms, the number of otolaryngology visits prior to diagnosis, and whether otolaryngologists diagnosed the disease in a cohort of MPS patients followed at an academic medical center. Twenty-three patients were evaluated. Age at diagnosis ranged from 0.2 to 33.0 years (median, 3.2 years). Prior to being diagnosed with MPS, 20/23 (87%) patients presented with at least one episode of otalgia, airway disorder, sleep disturbance, speech delay or suspected hearing loss. One patient had an adenotonsillectomy with paracentesis of tympanic membranes. Ten of the 23 patients (43%) were seen by an otolaryngologist before the diagnosis of MPS, none of which had the disease suspected during these visits. Notwithstanding limitations, our results suggest that increased awareness of MPS among otolaryngologists may allow for earlier diagnosis and better management of these patients.

scholarly journals C-07 Global Precedence: Examining Contributing Effects of Age and Cognitive Functioning

2019 ◽  
Vol 34 (6) ◽  
pp. 1034-1034
Author(s):  
M Johnson ◽  
J Lai ◽  
M Corona ◽  
G Lupas
Keyword(s):  
Cognitive Functioning ◽  
Medical Center ◽  
Linear Regression Analysis ◽  
Academic Medical Center ◽  
Clinical History ◽  
Global Precedence ◽  
Academic Medical ◽  
Mini Mental Status Examination ◽  
History Of ◽  
Global And Local

Abstract Objective Global precedence (GP) is an individual’s ability to readily identify global (gestalt) features when both global and local (internal) details are presented. Prior research shows that both age and neurodegenerative diseases, such as Alzheimer’s, affect GP. The goal of the current study is to examine differences in GP between individuals with early-onset Alzheimer’s disease (EOAD; before age 65) and healthy controls (HC). Method Fourteen EOAD patients and 6 HC’s recruited from Behavioral Neurology at an academic medical center were included in the current analysis. EOAD participants were diagnosed by clinical history, routine labs, neuroimaging, and neurological examination. Exclusion criteria included unstable medical conditions and history of severe head injury, psychotic disorder, or psychoactive substance use. All participants completed a Mini Mental Status Examination (MMSE) to assess overall cognitive functioning and a 4-item Navon's paradigm task (consisting of a larger letter whose shape is composed of smaller repeats of a different letter) to assess for GP. Results Linear regression analysis was performed, with the total score on Navon task as the dependent variable and age, MMSE score, and study group as predictor variables. Analysis yielded significant findings, suggesting a difference in GP performance between the two groups. However, coefficients suggested that while age did not contribute to the between-group difference, MMSE scores significantly accounted for our findings. In fact, when effects of MMSE scores were controlled, the between-group difference was no longer significant. Conclusion Findings suggest that individuals with EOAD perform worse on tasks of GP, which may be secondary to overall cognitive decline.

scholarly journals PCOS Features and Steroid Profiles Among Young Adult Women with a History of Premature Adrenarche

2021 ◽  
Author(s):  
Jussi Tennilä ◽  
Jarmo Jääskeläinen ◽  
Pauliina Utriainen ◽  
Raimo Voutilainen ◽  
Merja Häkkinen ◽  
...  
Keyword(s):  
Young Adult ◽  
Ovarian Function ◽  
Polycystic Ovary ◽  
Sex Hormone Binding Globulin ◽  
Hormonal Contraceptives ◽  
Adult Women ◽  
Young Adult Women ◽  
Premature Adrenarche ◽  
Steroid Profiles ◽  
History Of

Abstract Context Premature adrenarche (PA) may increase the risk for polycystic ovary syndrome (PCOS). Objective To study features of PCOS in young adult women with a history of PA. Design and participants Thirty PA and forty-two control females were followed from prepuberty to young adulthood (median age 18.1 years). Main outcome measures Ovarian function, the use of contraceptives, and clinical and biochemical indicators of hyperandrogenism. Results We found no differences in the use of hormonal contraceptives (50 vs 50%, PA vs controls, respectively; P > .999), indication for using contraceptives (P = .193), or in the history of oligo- (17 vs 26%, P = .392) and amenorrhea (0 vs 0%, P > .999). Among women not using hormonal contraceptives, those with a history of PA had a higher prevalence of hirsutism (27 vs 0%, P = .023) but not acne (87 vs 67%, P = .252). Steroid profiles were broadly comparable between the groups, but PA women had lower sex hormone-binding globulin (SHBG) concentrations (30.1 vs 62.4 nmol/l, P < .001) resulting in higher free androgen index (3.94 vs 2.14, P < .001). The difference in SHBG levels persisted through BMI adjustment. SHBG correlated negatively with HOMA-IR (r -0.498, P = .003). Anti-Mullerian hormone concentrations were comparable between the groups (39.3 vs. 32.1 pmol/l, P = .619). Conclusions PA was not associated with evident ovarian dysfunction in young adult women. However, women with a history of PA had decreased SHBG levels and thus, increased bioavailability of circulating androgens.

scholarly journals Hyperglycemia Alters Tumor Necrosis Factor-α Release from Mononuclear Cells in Women with Polycystic Ovary Syndrome

2005 ◽  
Vol 90 (9) ◽  
pp. 5336-5342 ◽  
Author(s):  
Frank González ◽  
Judi Minium ◽  
Neal S. Rote ◽  
John P. Kirwan
Keyword(s):  
Polycystic Ovary Syndrome ◽  
Mononuclear Cells ◽  
Polycystic Ovary ◽  
Medical Center ◽  
Academic Medical Center ◽  
Reproductive Age ◽  
Controlled Study ◽  
Oral Glucose ◽  
Ovary Syndrome ◽  
Glucose Ingestion

Abstract Context: Women with polycystic ovary syndrome (PCOS) are often insulin resistant and have chronic low-level inflammation. Objective: The purpose of this study was to determine the effects of hyperglycemia on lipopolysaccharide (LPS)-stimulated TNFα release from mononuclear cells (MNC) in PCOS. Design: The study was designed as a prospective controlled study. Setting: The study was carried out at an academic medical center. Patients: Sixteen reproductive age women with PCOS (eight lean, eight obese) and 14 age-matched controls (eight lean, six obese) participated in the study. Main Outcome Measures: Insulin sensitivity (IS) was derived from a 2-h 75-g oral glucose tolerance test (ISOGTT). Percentage of truncal fat was determined by dual-energy absorptiometry. TNFα release was measured from MNC cultured in the presence of LPS from blood samples drawn fasting and 2 h after glucose ingestion. Results: ISOGTT was lower in women with PCOS compared with controls (3.9 ± 0.4 vs. 6.3 ± 1.0; P < 0.03) and was negatively correlated with percentage of truncal fat (r = 0.56; P < 0.002). Truncal fat was greater in lean women with PCOS compared with lean controls (29.8 ± 2.6 vs. 23.8 ± 2.5%; P < 0.04). The TNFα response was different between obese and lean controls (−96.9 ± 21.2 vs. 24.4 ± 21.6 pg/ml; P < 0.03) and obese and lean women with PCOS (−94.1 ± 34.5 vs. 30.4 ± 17.6 pg/ml; P < 0.002). Fasting plasma C-reactive protein was elevated (P < 0.003) in obese PCOS and obese controls compared with lean controls. Conclusion: An increase in abdominal adiposity and increased TNFα release from MNC after hyperglycemia may contribute to insulin resistance in lean PCOS patients. In contrast, obese PCOS patients have more profound chronic inflammation, and thus may have LPS tolerance that protects them from relatively mild excursions in blood glucose.

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