PurposeA large number of medications have been implicated in the genesis of gynecomastia. However, gynecomastia is common in men, asymptomatic, increases with age, and is considered to be due to an increased estradiol/testosterone ratio. This complicates the interpretation of medication-related gynecomastia. Therefore, we have reviewed the literature in order to assess the data relating gynecomastia onset with utilization of specific medications.MethodsThe literature was searched in PubMed and the Ovid/Medline databases from the 1946 to January 2015 with the search terminology of “gynecomastia, drugs/medications.” A few other articles were found and included.ResultsOne hundred ten publications were reviewed. Sixty-three were single case reports. There were 24 population-based studies of which 8 were HIV-infected patients treated with antiretroviral agents. Among the case reports, 49 were for individual medications, and 2 were reports of antineoplastic or antiretroviral drug regimens. In the great majority, mastodynia with or without breast enlargement was present and referred to as gynecomastia. Generally, hormonal profiles could not explain the breast enlargement. The pain/tenderness and breast enlargement resolved spontaneously over time.ConclusionMany different medications have been associated with the presence of “gynecomastia.” Generally, it presents as a syndrome characterized by a single painful/tender breast (mastodynia) associated with breast enlargement and is transient. We suggest that these cases be referred to as an acute gynecomastia syndrome. This syndrome also occurs independent of medication use. Thus, in an individual patient, whether it is medication induced often remains uncertain. The pathogenesis remains unknown.

Background: IDegAsp is the first insulin co-formulation constituting 70% insulin degludec and 30% insulin aspart. In contrast to conventional premix analogues, degludec component of IDegAsp lowers variability, fasting glucose with comparable glycemic control and fewer hypoglycemic events. Re-suspension errors inherent to premix analogues also does not occur with IDegAsp. In routine diabetes practice, patients have customised A1c goals depending on the associated comorbidities and risk factors. Aim: To assess the safety and efficacy of IDegAsp in Indian T2D subjects in a real-world setting. Methods: T2D initiated on IDegAsp and on regular follow-up were de-identified from EMR. Clinical outcomes and hypoglycemic events were captured. n= 152, age= 52.9±11.9y, diabetes duration= 11.5±13.8y, 78.57% males, treatment duration= 10.3±6.5mths. Results: 92% of the patients achieved customised A1c targets.Reduction from baseline: 0.91% in A1c(p=0.0004), 41.4 mg/dL in FBS(p<0.0001), 0.80 kg in body weight(p=0.0083).Five hypoglycemic episodes were reported (none severe). There were no reported episodes of nocturnal hypos. Conclusion: In this real-world study involving T2D subjects in India, IDegAsp improved HbA1c and FBS significantly,with less hypoglycemia and no weight gain. Some of these outcomes are contrary to those reported in clinical trials and could have resulted from the new combination oral therapies. Disclosure J. Kesavadev: Advisory Panel; Self; Novo Nordisk India Private Limited. Speaker's Bureau; Self; Novo Nordisk India Private Limited. Advisory Panel; Self; Medtronic. Speaker's Bureau; Self; Medtronic. Advisory Panel; Self; Sanofi. Speaker's Bureau; Self; Sanofi. Research Support; Self; MSD. Speaker's Bureau; Self; MSD. Advisory Panel; Self; AstraZeneca. Speaker's Bureau; Self; AstraZeneca. B.D. Saboo: None. A. Shankar: None. A. David: None. R. Warrier: None. G. Krishnan: None. L. Ramachandran: None. S. Jothydev: None.

We describe a case where we effectively managed chronic, uncontrolled type 2 diabetes with hydroxychloroquine (HCQS) as an add on therapy, wherein the patient was on multiple oral hypoglycemic agents along with a combination of injectable incretin/insulin therapy prior to HCQS initiation. Six months into combination therapy with HCQS, the target HbA1c was achieved for the first time in the patient’s recent history at a much lower daily insulin dose (56% requirement drop), which has never been documented before. This combination also resulted in significant weight loss. We make a case for advocating the use of HCQS to the available routine diabetes therapeutic agents, especially if the blood sugars fail to achieve target levels in spite of being on intensive management with insulin and for the obese phenotype.

Probably for the first time in the history of medicine, through the applications of Regenerative Medicine we can talk about actually "curing" a chronic condition rather than manage these conditions for life or even provide robust solutions for life-threatening diseases, including deadly hematological cancers, diabetes or progressive neurological conditions like ALS. Although this field is becoming a frontier only in recent times, there is documented evidence of this science in older times, including during the Greek times. Prometheus was supposed to possess an immortal liver which was feasted by the eagle of Zeus; although this has mythological significance, it continues to be of significance today, where we know the liver is one of the organs that have a high regenerative capacity [1]. This exciting field continues to evolve with a new armamentarium of therapies available to treat or potentially cure chronic degenerative conditions that were not known to have a potential cure previously.

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