Exercise Promotion for Patients with Mental Health Conditions in Milton, VT

Depression and anxiety are two highly prevalent mental health conditions and can often occur together. Research shows that sustained low-intensity exercise releases chemicals that promote nerve cell growth in the brain, which helps regulate mood and relieve symptoms. Exercise may seem like a logical solution for mental health to those with a medical background, but may be a new idea to many patients who are unaware of the added benefits of staying active.https://scholarworks.uvm.edu/fmclerk/1536/thumbnail.jp

Advances in the treatment of prolactinomas

Prolactinomas account for approximately 40% of all pituitary adenomas and are an important cause of hypogonadism and infertility. The ultimate goal of therapy for prolactinomas is restoration or achievement of eugonadism through the normalization of hyperprolactinemia and control of tumor mass. Medical therapy with dopamine agonists is highly effective in the majority of cases and represents the mainstay of therapy. Recent data indicating successful withdrawal of these agents in a subset of patients challenge the previously held concept that medical therapy is a lifelong requirement. Complicated situations, such as those encountered in resistance to dopamine agonists, pregnancy, and giant or malignant prolactinomas, may require multimodal therapy involving surgery, radiotherapy, or both. Progress in elucidating the mechanisms underlying the pathogenesis of prolactinomas may enable future development of novel molecular therapies for treatment-resistant cases. This review provides a critical analysis of the efficacy and safety of the various modes of therapy available for the treatment of patients with prolactinomas with an emphasis on challenging situations, a discussion of the data regarding withdrawal of medical therapy, and a foreshadowing of novel approaches to therapy that may become available in the future

Impact of Interactions Between First Responders and Opioid Drug Users

INTRODUCTION In 2017, First Responders (EMS, Police, and Fire Department) in Vermont administered 848 doses of naloxone (Narcan®), an opioid antagonist that can block the effects of opioids in overdose. However, the rate of opioid-related fatalities has continued to rise from 74 in 2015 to 101 in 2017. Vermont CARES, a nonprofit organization, helps address this issue by working “for and with Vermonters affected by HIV/AIDS to promote well-being through a continuum of prevention, support, and advocacy services.” Their syringe service programs throughout the state provide access to clean needles, overdose prevention education, and naloxone. AIMS 1. To better understand the perceived experience of opioid drug users (Vermont CARES clients) when interacting with First Responders following an overdose. 2. To explore how such interactions of a Vermont CARES client – essentially as positive or negative – affects the likelihood to request such help in the futurehttps://scholarworks.uvm.edu/comphp_gallery/1279/thumbnail.jp

Future treatment strategies of aggressive pituitary tumors

While surgery remains the first-line treatment of most aggressive pituitary adenomas, medical therapy is important as second-line or adjunctive therapy in a large proportion of patients. Dopamine agonists (DAs) are the best treatment for prolactinomas, but when DAs are not tolerated, new somatostatin receptor subtype 5 (SSTR5) inhibitors may offer an alternative in the future. Unfortunately, these are unlikely to be effective in DA-resistant prolactinomas. In acromegaly, the existing somatostatin analogs, octreotide and lanreotide, will remain the medical treatment of choice for the foreseeable future. There is an urgent need for medical therapies in Cushing’s disease, and the SSTR5 analogs could offer an effective treatment in a proportion of patients within the next few years. Finally, the medical management options for non-functioning pituitary adenomas are also very limited, and a new chimeric agent with activity towards dopamine receptors, SSTR5 and SSTR2 may help reduce adenoma recurrence in the future

Efficacy and safety of oral semaglutide in patients with type 2 diabetes and moderate renal impairment (PIONEER 5): a placebo-controlled, randomised, phase 3a trial

Background: Oral semaglutide is the first oral glucagon-like peptide-1 (GLP-1) receptor agonist for glycaemic control in patients with type 2 diabetes. Type 2 diabetes is commonly associated with renal impairment, restricting treatment options. We aimed to investigate the efficacy and safety of oral semaglutide in patients with type 2 diabetes and moderate renal impairment. Methods: This randomised, double-blind, phase 3a trial was undertaken at 88 sites in eight countries. Patients aged 18 years and older, with type 2 diabetes, an estimated glomerular filtration rate of 30–59 mL/min per 1·73 m2, and who had been receiving a stable dose of metformin or sulfonylurea, or both, or basal insulin with or without metformin for the past 90 days were eligible. Participants were randomly assigned (1:1) by use of an interactive web-response system, with stratification by glucose-lowering medication and renal function, to receive oral semaglutide (dose escalated to 14 mg once daily) or matching placebo for 26 weeks, in addition to background medication. Participants and site staff were masked to assignment. Two efficacy-related estimands were defined: treatment policy (regardless of treatment discontinuation or rescue medication) and trial product (on treatment without rescue medication) in all participants randomly assigned. Endpoints were change from baseline to week 26 in HbA1c (primary endpoint) and bodyweight (confirmatory secondary endpoint), assessed in all participants with sufficient data. Safety was assessed in all participants who received at least one dose of study drug. This trial is registered on ClinicalTrials.gov, number NCT02827708, and the European Clinical Trials Registry, number EudraCT 2015-005326-19, and is now complete. Findings: Between Sept 20, 2016, and Sept 29, 2017, of 721 patients screened, 324 were eligible and randomly assigned to oral semaglutide (n=163) or placebo (n=161). Mean age at baseline was 70 years (SD 8), and 168 (52%) of participants were female. 133 (82%) participants in the oral semaglutide group and 141 (88%) in the placebo group completed 26 weeks on treatment. At 26 weeks, oral semaglutide was superior to placebo in decreasing HbA1c (estimated mean change of −1·0 percentage point (SE 0·1; −11 mmol/mol [SE 0·8]) vs −0·2 percentage points (SE 0·1; −2 mmol/mol [SE 0·8]); estimated treatment difference [ETD]: −0·8 percentage points, 95% CI −1·0 to −0·6;

SAT-222 Aggressive Phenotype Pheochromocytoma Associated with NF-1 and BRCA Mutation

Abstract Introduction Pheochromocytomas are catecholamine-secreting tumors of the adrenal medulla that occur sporadically or with familial association. Familial predilection occurs in those with multiple endocrine neoplasia type 2, von Hippel-Lindau disease, and neurofibromatosis Type 1 (NF-1). To date, more than 21 gene mutations have been identified that are involved in the development of pheochromocytomas. However, co-existence of two different mutations such as NF-1 and BRCA gene mutations with pheochromocytoma has not been well described. Clinical Case A 40 year-old woman with NF-1 and recently diagnosed left breast invasive ductal carcinoma, estrogen positive, progesterone positive, HER-2 negative BRCA2 positive breast cancer and right breast lobular carcinoma in situ underwent staging CT scan. A 2.7 cm left adrenal incidentaloma with heterogeneous texture and 69–100 HU was discovered. Symptom review revealed chronic headaches and increasing frequency of anxiousness and irritability. She had no personal or family history of hypertension. Laboratory analysis showed elevated catecholamine levels included plasma normetanephrine of 2.8 nmol/L (normal &amp;lt;0.9), metanephrine of 0.9 nmol/L (normal &amp;lt;0.5), 24 hour urine metanephrine 498 mcg/24 hr (normal &amp;lt;180) and 24 hour urine normetanephrine of 1,152 mcg/24 hr (normal &amp;lt;451). Findings were consistent with adrenal pheochromocytoma. She was immediately started on phenoxybenzamine and encouraged to increase fluid intake to expand intravascular volume before surgery. She underwent laparoscopic left partial adrenalectomy fourteen days later. Surgical pathology revealed a 3.0 cm pheochromocytoma in a background of nodular hyperplasia of the medulla, described as an aggressive tumor phenotype based on morphological features. Conclusions It has been estimated that 1.5–14% of adrenal incidentalomas are pheochromocytomas. While only 3% of NF-1 patients have pheochromocytomas, 20–50% of NF-1 patients with concurrent hypertension have underlying chromaffin tumors. This association is significant when compared to the pheochromocytoma incidence of 0.1% in all hypertensive individuals. Interestingly, germline mutations of BRCA-1 associated protein-1 gene have been reported in patients with paragangliomas, therefore it may be plausible to consider interactions between NF-1 and breast cancer BRCA-2 gene mutations, resulting in an unusual and more aggressive pheochromocytoma phenotype, even when detected at an early stage, as in this case. It is also important to recognize and adequately treat pheochromocytoma prior to having surgery to avoid possible intraoperative hypertensive crisis, a concept that was underscored in this particular case when the patient was relatively asymptomatic and entirely normotensive preoperatively.</jats:p

FEMALE DISCRIMINAION AT JAPANESE WORKPLACES IN BANGKOK METROPOLITAN REGION, THAILAND

The purpose of this study was to find female discrimination at Japanese workplaces in Bangkok metropolitan region because Japanese working system contain high female discrimination and gender inequality. Thus it was interesting to know the situation of female discrimination in Japanese firms in Thailand whether it exists or not. In this thesis, the feminist research approach was used as the main framework, and the quantitative method as the main research method. For the quantitative analysis, the 120 e-questionnaires were sent to the Thai female workers at Japanese firms in Bangkok metropolitan region. There were 77 answered respondents. In the questionnaire, the questions were divided into two parts which are general questions and female discrimination-related questions. SPSS was utilized as the main program for statistical analysis. In SPSS, descriptive statistics: frequency and tabulation, and correlation, were analyzed. The conclusions were that Thai female employees do not feel that they are discriminated, and high-salary women feel dissatisfied with their remuneration