Global rates of obesity and Type 2 diabetes mellitus (T2DM) are increasing globally concomitant with a rising prevalence of sleep deprivation and sleep disorders. Understanding the links between sleep, obesity and T2DM might offer an opportunity to develop better prevention and treatment strategies for these epidemics. Experimental studies have shown that sleep restriction is associated with changes in energy homeostasis, insulin resistance and β-cell function. Epidemiological cohort studies established short sleep duration as a risk factor for developing obesity and T2DM. In addition, small studies suggested that short sleep duration was associated less weight loss following lifestyle interventions or bariatric surgery. In this article, we review the epidemiological evidence linking sleep duration to obesity and T2DM and plausible mechanisms. In addition, we review the impact of changes in sleep duration on obesity and T2DM.
Congenital bronchogenic cysts of the lung and mediastinum develop from the ventral foregut during embryogenesis. Bronchogenic cysts are seldom seen in the adults and most are thought to be asymptomatic and free of complications unless they become infected or are large enough to cause pressure on contiguous vital structures such as the tracheal carina, the lung or the esophagus. We present the unique case of a 24-year-old man who developed respiratory symptoms after Salmonella enteritidis infected bronchogenic cyst following Salmonella gastroenteritis. q 2002 Elsevier Science B.V. All rights reserved.Keywords: Bronchopulmonary foregut malformations; Bronchogenic cyst; Mediastinum; Salmonella enteritidis; Gastroenteritis Case reportA previously healthy 24-year-old man was admitted to the hospital with complaints of chest pain, mild non-productive cough and shortness of breath. Symptoms were initiated 10 h before admission and progressively became more severe. Review of medical history was relevant for symptoms of gastroenteritis 3 days prior to presentation. He had fever, vomiting, nausea, cramping abdominal pain and diarrhea and he had been treated symptomatically for viral gastroenteritis. Pulmonary examination revealed decreased breath sounds of the left lower hemithorax and rales. Vital signs included a blood pressure of 130/85 mmHg, heart rate of 90 beats per minute, respirations of 20 per minute while oxygen saturation was 94% on room air. Routine laboratory studies were unremarkable. Chest radiograph revealed an unsuspected, well-circumscribed retrocardial mass in the lower left hemithorax, without an air-fluid level. Computed tomography showed a large unilocular cyst (transverse diameter 9 cm, 18 Hounsefield units) located behind the pericardium, paravertebral, adjacent to the aorta and the esophagus (Fig. 1). Fiberoptic bronchoscopy examination revealed a normal tracheobronchial tree. Esophagogastroscopy showed a slight extrinsic compression of the distal third of the esophagus with intact mucosa and normal peristalsis.Left thoracotomy was subsequently performed. A large encapsulated cyst, located just above the left diaphragm was identified. The cyst compressed the basic segments of the left lower lobe and partially involved the esophageal wall but had no communication with the tracheobronchial tree or the lung parenchyma. Dissection of the cyst was complicated by extensive pericystic adhesions and for complete excision esophagomyotomy was required. A specimen from cyst content was submitted for microbial culture. Results were surprisingly interesting. A lactose negative microorganism was isolated and identified by PASCO MIC/ID and Api 20E as Salmonella spp. The serological identification showed that the isolated bacterium was Salmonella enteritidis. Taking into account symptoms of gastroenteritis prior to admission, blood sample and stool were then submitted for microbial culture. Blood culture was negative whereas stool culture was positive for Salmonella enteritidis. The susceptibility test sh...
Impact of early glomerular fi ltration rate decline in response to antihypertensive treatment on risk of end-stage kidney disease and cardiovascular outcomes: a systematic review and meta-analysis: Erratum
Differentiated thyroid cancer (DTC) represents the most common form of thyroid neoplasms and is becoming increasingly prevalent. Evidence suggests a possible relationship between DTC diagnosis and subsequent atrial fibrillation (AF). If confirmed, this may present an alarming health risk (AF) in an otherwise condition with a relatively good prognosis (DTC). The aim of this systematic review and meta-analysis is to provide for the first time a pooled estimate of AF incidence in DTC patients in comparison to healthy controls. A detailed search in electronic databases, clinical trial registries and grey literature was performed to identify studies reporting the incidence of AF in DTC patients. Newcastle-Ottawa quality assessment scale was used to assess study quality. We used a random effects (RE) generalized linear mixed model (GLMM) in pooling of individual studies and also calculated a prediction interval for the estimate of a new study. Six observational studies met the eligibility criteria, which included totally 187,754 patients with DTC and 199,770 healthy controls. The median follow-up period was 4.3 to 18.8 years; the incidence rate of AF was 4.86 (95% CI, 3.29 to 7.17, I2= 96%) cases per 1000 person-years, while the incidence rate ratio was 1.54(95%CI, 1.44 to 1.65, I2 = 0%, 95%PI, 1.33 to 1.78).This is the first meta-analysis to confirm that patients with DTC are at a high risk for developing AF, which may be attributed to a state of iatrogenic hyperthyroidism due to long-term thyrotropin suppression therapy.
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