Objectives Epicardial adipose tissue (EAT) thickness, a novel marker of cardiovascular disease (CVD), is increased in children with a healthy weight and type 1 diabetes (T1D). The prevalence of obesity has increased in children with T1D and may confer additional CVD risk. The purpose of this study was to examine EAT thickness in youth with and without T1D in the setting of overweight/obesity. Methods Youth with overweight/obesity and T1D (n=38) or without T1D (n=34) between the ages of 6–18 years were included in this study. Echocardiogram using spectral and color flow Doppler was used to measure EAT and cardiac function. Waist circumference, blood pressure, and HbA1c, were used to calculate estimated glucose disposal rate (eGDR) to estimate insulin resistance in children with T1D. Results EAT thickness was not significantly different in youth with T1D compared to controls (2.10 ± 0.67 mm vs. 1.90 ± 0.59 mm, p=0.19). When groups were combined, EAT significantly correlated with age (r=0.449, p≤0.001), BMI (r=0.538, p≤0.001), waist circumference (r=0.552, p≤0.001), systolic BP (r=0.247, p=0.036), myocardial performance index (r=−0.287, p=0.015), ejection fraction (r=−0.442, p≤0.001), and cardiac output index (r=−0.306, p=0.009). In the group with T1D, diastolic BP (r=0.39, p=0.02) and eGDR (r=−0.48, p=0.002) correlated with EAT. Conclusions EAT was associated with measures of adiposity and insulin resistance but does not differ by diabetes status among youth with overweight/obesity. These findings suggest that adiposity rather than glycemia is the main driver of EAT thickness among youth with T1D.
Physician wellness plays an important role in healthcare. Providers are constantly exposed to long work hours and stressful events which may lead to fatigue and burn out. Burnout has been linked to decrease in patient satisfaction and quality of care. It has also been associated with higher physician/staff turnover, physician substance abuse, higher medical error rates and malpractice risk. In the last few years, there has been tremendous push by ACGME to address physician/resident burn out. In 2015, the official data of ACGME physician survey illustrated burn out in 46% of in training physicians. The aim of our study is to assess parameters that include physician satisfaction with their work hours, dietary habits and routine physical activity. The survey was distributed to all hospital departments at our community based hospital. Total 104 residents and attendings participated in the study. 50% of the participants reported BMI higher than normal range. 31.4% reported eating 4 servings of vegetable 1-2 times a week, only 6.9% reported eating vegetables 7 days a week. 70% of participants reported not accounting for caloric content during meal preparation, 33% reported having no basic knowledge of calorie counting. However, majority of respondents reported 5 on a scale of 1-5 with 5 being the most comfortable in regards to counseling patients on dietary recommendations. Although 34.5% of participants reported to be "extremely comfortable" and 32.4% "somewhat comfortable" with counseling patients on exercise, only 6.9 % of participants reported performing moderate intensity exercising at least 5 times a week. However, 49% of participants reported not participating in strength training sessions. The majority of respondents (73.5%) cited lack of time as the main barrier to achieving the recommended physical activity guidelines. Our survey results suggest that physician have limited access to meeting basic nutrition requirement during work hours. Although majority of physicians report being comfortable in counseling patient, they themselves don’t participate in routine physical activity. Long work shifts and poor nutritional quality of cafeteria food were important factors in our survey. Physical activity counseling has been found to reflect a physician’s own personal exercise habits, which affects patient care. As suggested in other studies, our participants also cited lack of time, and limited access to nutrition during the work day. With these results, we aim to raise awareness of the shortcomings of physician wellness and look for ways for improve our overall well being in an effort to provide better patient care.
Background: Swyer Syndrome is an extremely rare disorder of sexual development. These patients often present with primary amenorrhea during adolescence and are phenotypically female with 46 XY chromosomes. Given the association of invasive gonadal malignancies with this disorder, suspicion should be high in patients who present with a stagnant or decreased rate of pubertal progression. We present a case of Swyer Syndrome in a 14-year-old female with primary amenorrhea in the setting of decreased pubertal progression. Case: A 14-year-old female presents with a chief complaint of primary amenorrhea. She first noticed breast budding 2 years prior but reports no significant increase in breast tissue over the last 2 years. She does not appreciate any other signs of puberty. She denies any acne, body odor, hirsutism, hair loss, or abdominal/pelvic pain. She denies any changes in her diet or physical activity and is not on any medication. No history of cancer, surgeries, or radiation exposure. There is no family history of infertility or delayed puberty. Her vitals on presentation are within normal limits. Her growth parameters are the following: weight-69.9 kilos, height-163 cm, and BMI-26.3. Physical exam shows a well-appearing adolescent with grossly female external genitalia and the breast exam is SMR II. No pubic or axillary hair appreciated on the exam. Although our patient did not meet the traditional definition of primary amenorrhea, a workup was started due to the slow progression of puberty. Initial blood testing shows normal blood count, electrolytes and thyroid levels. DHEA-S androstenedione, free and total testosterone were all within normal limits. Further results such as LH (25.4 uIU/mL), FSH (56.5 mIU/mL) and estradiol (22 pg/mL) along with low levels of AMH (0.52 ng/mL) and inhibin A (1pg/mL) confirms suspicion for ovarian insufficiency. Chromosomal analysis and pelvic ultrasound findings of a small uterus and ovaries led to our diagnosis of Swyer syndrome. Our patient had surgical resection of both ovaries and fallopian tubes and the ovarian pathology showed gonadoblastoma with invasive dysgerminoma in both gonads. She was started on hormone replacement after gonadectomy. Conclusion: Although Swyer syndrome is uncommon with an incidence of 1 in 80,000, this case illustrates that suspicion for Swyer Syndrome should be high in patients with slow progression of puberty and primary amenorrhea (1). Early diagnosis is critical, as patients with gonadal dysgenesis are at great risk for germ cell cancers. Though most of these patients have an identifiable genetic mutation, we were unable to elicit the exact mutation in our patient despite whole-genome sequencing. References: Jaideep Khare, Prasun Deb, Prachi Srivastava & Babul H. Reddy (2017) Swyer syndrome: The gender swayer?, Alexandria Journal of Medicine, 53:2, 197–200, DOI: 10.1016/j.ajme.2016.05.006 Varshini Chakravarthy, Sehar Ejaz. A 16-Year-Old With Amenorrhea and Delayed Breast Development - Medscape - Jan 14, 2020
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