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Linked content This article is linked to Patel et al and Patel and Hunt papers. To view these article visit https://doi.org/10.1111/apt.14411 and https://doi.org/10.1111/apt.14505.

Aim Cystic fibrosis (CF) patients are at high risk of developing CF-related diabetes (CFRD). In non-CF patients, liver disease, specifically steatosis and non-alcoholic fatty liver disease (NAFLD), is strongly associated with type 2 diabetes. We compared glycemic status and metabolic profiles in CF patients according to a biomarker of hepatic injury, alanine aminotransferase (ALT). Methods We conducted a cross-sectional study among 273 adult CF patients recruited from the Montreal CF Cohort. A 2-hour oral glucose tolerance test (OGTT) was performed to collect glucose and insulin measures every 30 minutes. Fasting ALT levels and anthropometric measures were also obtained. Patients were categorized into 2 groups based on ALT cut-off of 25 U/L. Results Patients in the high ALT group were mostly men (83%), had higher mean weight and BMI (p<0.001) and showed elevated glucose levels throughout OGTT (p≤0.01). When stratified by sex, only men with high ALT showed significantly higher weight (p<0.001), higher glycemic values at 60, 90 and 120 minutes of OGTT (p≤0.01), higher frequency of de novo CFRD (20.5% vs 8.2%, p = 0.04) as well as lower insulin sensitivity than men with normal ALT (p = 0.03). ALT levels were strongly associated with HOMA-IR in CFRD patients (p = 0.001, r 2 = 0.28). Conclusions Adult CF men with higher ALT show an increased frequency of dysglycemia and de novo CFRD, lower insulin sensitivity and higher eight. Our data suggests that ALT levels could be an interesting tool to guide targeted diabetes screening, particularly among CF men. Prospective studies are needed to confirm these observations.

poses a risk for extrapyramidal symptoms. Quetiapine is considered first line, because it appears to have the lowest risk. The following describes the case of a patient with PD who developed dystonia after only one dose of quetiapine. DESCRIPTIONAn 80-year-old Caucasian man with a 4-year history of idiopathic PD with dementia had new-onset hallucinations, describing ''cats in the walls,'' 2 weeks before presentation. This escalated to aggressive behavior toward his wife and falls that resulted in hospitalization.His past medical history was remarkable for PD since 2003, a diagnosis of dementia in 2006, and hypertension. He was dependent in activities of daily living except eating. Medications were carbidopa/levodopa, 25/100 mg 1.5 tab three times a day; verapamil; hydrochlorothiazide/triamterene; fosinopril; citalopram; and trazodone.At admission, he had stable vital signs, and he was alert and awake, but with limited attention. Oriented to person only, he was unable to answer most questions appropriately. Physical examination was remarkable for cog wheeling and rigidity in all four extremities. Laboratory studies upon admission showed a blood urea nitrogen of 20 mg/dL and serum creatinine of 1.8 mg/dL.His mental status improved with intravenous hydration, but the aggressive behavior continued. A trial dose of quetiapine 12.5 mg orally was given. Within 3 hours of administration, the patient became more restless with increased muscle tone, twitching and spasms of arms and legs, and contracture-like positioning, but he remained afebrile with stable vital signs. Evaluation was negative for stroke, seizure, infection, or cardiac disease, suggesting a reaction to quetiapine manifested as dystonia and restlessness. Quetiapine was discontinued, and lorazepam was used to control agitation and relax the musculature. Dystonic symptoms improved within 48 hours, and after stabilization of other medical problems, the patient was transferred to a skilled nursing facility for ongoing care. DISCUSSIONThe presence of hallucinations a few weeks before hospitalization led to a presumptive diagnosis of LBD. Patients with LBD are sensitive to the emergence of extrapyramidal symptoms such as akathisia, rigidity, and dystonia associated with antipsychotics. The interaction between an atypical antipsychotic such as quetiapine and an abnormal basal ganglia system, along with use of dopaminergic agents, could cause this dystonic reaction, as suggested by the time course. In addition, this patient was taking a selective serotonin reuptake inhibitor, which has also been associated with extrapyramidal symptoms. 1 The addition of quetiapine could prompt a detrimental serotoninergicdopaminergic imbalance. 2 In the case of this patient, reversibility of dystonia after quetiapine discontinuation suggests causality.Based on review of the literature, this is the third case reported of a patient with PD and new-onset hallucinations suggestive of LBD who developed a dystonic reaction after quetiapine. This patient was similar to a previous case, a ...