Dorothy A. Fink

Elevated 1-hour plasma glucose levels are associated with dysglycemia, impaired beta-cell function, and insulin sensitivity: a pilot study from a real world health care setting

Individuals with prediabetes, namely impaired glucose tolerance (IGT) and/or impaired fasting glucose (IFG), are at increased risk of developing type 2 diabetes mellitus (T2DM) and cardiovascular disease. However, only 30–40 % of those with IFG/IGT eventually develop T2DM [1–3]. In fact, about 40 % of individuals who develop T2DM after 10 years have Normal Glucose Tolerance (NGT) at baseline [3], indicating that the conventional fasting and 2-h oral glucose tolerance test (OGTT) do not recognize most high-risk individuals. Recently, population-based studies have consistently shown that 1-h post-load glucose (PG) levels may be a better predictor of T2DM and associated complications [4– 7]. Furthermore, NGT individuals with elevated 1-h PG[ 8.6 mmol/l were found to be more insulin resistant, and have worse beta-cell function and an atherogenic profile similar to those with prediabetes [8, 9]. These results were from a research setting using well-defined cohorts. There is sparse information regarding the performance of a 1-h OGTT in a health care setting where the population may be more heterogeneous. Therefore, we investigated the pathophysiological associations of NGT with elevated 1 h ([8.6) glucose levels with dysglycemic conditions in a cohort of outpatients undergoing screening for T2DM.

New strategies in the prevention of restenosis.

Restenosis is a common and serious complication following angioplasty and stent implantation in patients with arterial vascular disease. Restenosis is a form of intimal hyperplasia. Endothelin-1 (ET-1) and vascular endothelial growth factor (VEGF) stimulate intimal hyperplasia and may play a role in restenosis. ET-1 and VEGF may act in concert in promoting restenosis following mechanical injury to the vessel wall in angioplasty and stent implantation. An understanding of their mechanism of action may lead to more effective methods for preventing restenosis. ET-1 receptor antagonists may play a prominent role in prophylaxis.

Uric Acid Dye Inclusion Crystals

ABSTRACT Crystallization in the presence of molecular dye probes has been used as a means of discerning surface recognition events that occur during the growth of uric acid (UA) and uric acid dihydrate (UAD), which are known components of some human kidney stones. The growth of synthetic UA and UAD crystals from supersaturated aqueous solutions containing seven different cationic dyes (Thionin, New Methylene Blue, Neutral Red, Acridine Yellow G, Safranine O, Bismarck Brown Y, and Bismarck Brown R) yielded dye-included crystals in all cases. Herein we describe the specific inclusion patterns and/or habit modification resulting from these growth conditions.

Thromboembolic disease and cancer: possible new treatments.

Hypoxia-induced endothelin (ET) and vascular endothelial growth or permeability factor (VEGF) play an important role in tumor biology by promoting angiogenesis. Angiogenesis alters hemostasis and promotes thromboembolic disease (TED). Therapeutic angiogenesis directed against ET and VEGF may reduce the incidence of TED in cancer patients.

Diabetes as a model for the disparate public response to acute versus chronic diseases

The public health outcry toward infectious entities appears to dwarf chronic diseases such as diabetes. This disparity is particularly astonishing given the considerable prevalence of diabetes and prediabetes. Diseases associated with short-term morbidity and mortality therefore seem to garner attention and demand an immediate public health response, whereas chronic illnesses, which can be considerably more devastating in the longer term, receive relatively less notoriety. It should not, however, be misconstrued that one disease entity is more important than the other—it is critical that both acute and chronic entities are given balanced attention in the public health, governmental, and scientific realms. The current perspective reflects on the disparate public health purviews toward acute and chronic illnesses, describes why prevention is so difficult and challenging, and addresses what can be done to reverse this trend. If there is any hope of conquering the spiraling prediabetes and diabetes epidemics, the medical community must grapple with the complex issues herein raised.

Hypercalcemia Associated with Local and Ectopic Hormone Production

Hypercalcemia is a common endocrine problem. The most common causes of hypercalcemia are primary hyperparathyroidism in the outpatient and malignancy in the inpatient settings. Together, these two causes of hypercalcemia account for approximately 90% of all cases. Both primary hyperparathyroidism and malignancy have easily recognized laboratory patterns with the proviso that renal function is normal and the patient is not concomitantly taking vitamin D supplementation. It is important to note that although PTH and PTHrP share intense homology at their N-termini, primary hyperparathyroidism is typically associated with levels of 1,25(OH) 2 D that are in the upper range of normal or frankly elevated. PTHrP-mediated hypercalcemia does not usually cause elevations in 1,25(OH) 2 D concentrations. This chapter focuses on less common etiologies of hypercalcemia including local and ectopic hormone syndromes.

Inpatient Management of Type 2 Diabetes

1. To understand the goals for inpatient glycemic control in patients with type 2 diabetes. 2. To learn the treatment options of hyperglycemia in the inpatient setting. 3. To gain an appreciation for inpatient diabetes management in special situations in the hospitalized patient.