Shahinul Alam, Mohammad Jahid Hasan, Md. Abdullah Saeed Khan, Mahabubul Alam and Nazmul Hasan
Background and Objectives
Weight reduction has evidenced benefit on attenuation of histological activity and fibrosis of nonalcoholic steatohepatitis (NASH), but there is scarcity of data for lean NASH subgroup. We have designed this study to compare the effects of weight reduction on histological activity and fibrosis of lean and non-lean NASH.
We have included 20 lean and 20 non-lean histologically proven NASH patients. BMI < 25 kg/m2 was defined as non-lean. Informed consent was taken from each subject. All methods were carried out in accordance with the Declaration of Helsinki. Moderate exercise along with dietary restriction was advised for both groups for weight reduction. After 1 year, 16 non-lean and 15 lean had completed second liver biopsy.
Age, sex, alanine transaminase (ALT), aspartate aminotransferase (AST), gamma-glutamyltrasferase (GGT), Homeostasis model assessment insulin resistance (HOMA-IR), triglyceride and high density lipoprotein (HDL) was similar in both groups. Steatosis, ballooning, lobular inflammation, nonalcoholic fatty liver disease activity score (NAS) and fibrosis was similar in the two groups. In lean/non-lean group, any amount of weight reduction, ≥ 5% weight reduction and ≥ 7% weight reduction was found in respectively 8/11, 5/6 and 2/6 patients. In both lean and non-lean groups, weight reduction of any amount was associated with significant reduction of steatosis, ballooning and NAS, except lobular inflammation and fibrosis. In both groups, weight reduction of ≥ 5% was associated with significant reduction in NAS only. However, significant improvement in NAS was noted with ≥ 7% weight reduction in non-lean group only.
Smaller amount of weight reduction had the good benefit of improvement in all the segments of histological activity in both lean and non-lean NASH.
Hamda Houssein Ahmed, David De Bels, Rachid Attou, Patrick M. Honore and Sebastien Redant
Lactic acidosis results from an acid-base balance disorder of the body due to an excess of lactic acid. It is frequently found in critically ill patients admitted to the intensive care. The most common cause is type A, found in pathologies such as cardiogenic, septic and hypovolemic shock, trauma and severe hypoxemia. The type B is less common and arises without evidence of tissue hypoperfusion or shock. Divers etiologies have been described for this type of hyperlactatemia: Grand Mal seizures, liver failure, hematologic malignancies, congenital enzyme deficiencies, thiamine deficiencies and diabetes mellitus and also alcohol abuse, which may induce a lactic acid under-use or an increased production. The authors describe a rare complication of type 1 Diabetes Mellitus (T1DM), leading to a major and persistent expression of a type B lactic acidosis during ketoacidosis.
Guoxin Wang, Xiang Liu, Sheng Wang, Nan Ge, Jintao Guo and Siyu Sun
Recently, with the advancement of techniques, endoscopic ultrasound-guided therapies have shown distinct advantages, especially in relieving benign and malignant gastric outlet obstruction (GOO), as well as in postoperative pancreaticobiliary diseases. Herein, we present five currently used approaches in endoscopic ultrasound-guided gastroenterostomy (EUS-GE) using lumenapposing biflanged metal stents (LAMS), along with several examples of LAMS-based EUS treatment of pancreaticobiliary diseases. Compared with traditional treatment methods, EUS-guided procedures have – to some degree – shown higher success rates, both technical and clinical. Moreover, EUS-guided therapies reduce the risk of multiple surgical adverse events, including delayed gastric emptying, prolonged hospital stay, increased costs, and delay in cancer treatment. Particularly in terms of postoperative pancreaticobiliary diseases, EUS-guided therapy has assumed an essential role as a treatment option in cases where traditional methods are difficult to perform. Nevertheless, EUS-guided gastrointestinal procedures are still relatively new, with some clinical failures, and additional prospective clinical trials are warranted.
Herbert Spapen, Johan van Laethem, Maya Hites, An Verdoodt, Marc Diltoer and Patrick M. Honoré
Background and Objectives
High-dose colistin (COL) ensures adequate treatment of pneumonia caused by multidrug resistant gram-negative bacteria (MDR-GNB) but must be weighed against a higher risk of nephrotoxicity. Continuous veno-venous hemofiltration (CVVH) clears COL by filtering and membrane adsorption that permits to avoid dose accumulation and excessively high peak concentrations. We evaluated clinical/microbiological efficacy of the high-dose COL treatment under CVVH in patients with newly diagnosed MDR-GNB ventilator-associated pneumonia (VAP).
Observational cohort study in critically ill adult patients with MDR-GNB VAP. Colistimethate sodium (CMS) was administered as a 9 million international units (MIU) of loading dose followed by 3 × 4.5 MIU daily. CVVH was performed over a highly adsorptive membrane. Clinical and microbiological efficacies were assessed at the end of therapy. In survivors, serum creatinine level was evaluated before and at the end of therapy.
Fourteen patients (8 male patients, aged 57 ± 14 years) were consecutively included. Isolated pathogens were Pseudomonas aeruginosa in 7, Klebsiella pneumoniae in 5, and other Enterobacteriaceae in 2 patients. A favorable clinical response was observed in 9 patients (64%). Full and presumed microbiological eradication was observed in 12 patients (86%). Two patients were diagnosed with Stage 1 acute kidney injury.
In patients with MDR-GNB VAP, CVVH may represent an interesting option to enable effective high-dose COL treatment.
Nicolae-Marius Cason, Petru Aurel Babeş, Enikő Béres and Katalin Babeş
Background and aims. Patients with schizophrenia have a shorter life expectancy than normal population partially due to the metabolic side effects of antipsychotic treatment. The aim of this study is to evaluate the long-term evolution of the metabolic syndrome in chronic schizophrenia patients on fixed second generation antipsychotics (SGA).
Material and method. The components of metabolic syndrome were evaluated repeatedly in a minimum 6 months and maximum 2 years follow-up period. The presence of metabolic syndrome (MetS) and metabolic risk scores (cMetS) according to National Cholesterol Education Program Adult Treatment Panel III were calculated and compared in time. In the prevalence, incidence and normalization logistic regression studies included all the known risk factors together with the follow-up period. Finally, all these rates were compared depending on the type of SGA.
Results. Only cMetS, waist circumference and diastolic blood pressure presented significant increase in the follow-up period which was in average 385.5 days. The prevalence of MetS at base-line was 39.4%, which increased to 48.5% after the follow-up period. The calculated incidence of 30% was associated with a 23.1% rate of normalization. Logistic regression studies revealed as independent risk factors the age and base-line cMetS/weight for incidence and for normalization. In the aripiprazole group the normalization rate exceeded the incidence rate (33.3% vs 20%).
Conclusions. The results emphasize the highly dynamic character of the metabolic syndrome even in chronic schizophrenia patients with fixed SGA regimen. The normalization of MetS is a possibility that should not ignored. The age and weight continue to remain independent risk factors, thus close monitoring in elderly and strict weight control plan are necessary. Aripiprazole showed better safety profile, but more extensive studies are required for definitive conclusions.
David M. Garner, Naiara Maria de Souza, Vitor E. Valenti and Luiz Carlos M. Vanderlei
Backgound and aims. In this study we analyzed heart rate variability (HRV) via chaotic global techniques so as to discriminate diabetics from control subjects. Matherial and method. Chaotic global analysis of the RR-intervals from the electrocardiogram and preprocessing adjustments were undertaken. The effect of varying two parameters to adjust the Multi-Taper Method (MTM) power spectrum were evaluated. Then, cubic spline interpolations from 1Hz to 13Hz were applied whilst the spectral parameters were fixed. Precisely 1000 RR-intervals of data were recorded. Results. CFP1 and CFP3 are the only significant combinations of chaotic globals when the default standard conditions are enforced. MTM spectral adjustments and cubic spline interpolation are trivial at effecting the outcome between the two datasets. The most influencial constraint on the outcome is data length. Conclusion. Chaotic global analysis was offered as a reliable, low-cost and robust technique to detect autonomic dysfunction in subjects with diabetes mellitus.
Remzi Bahsi, Deniz Mut Sürmeli, Tuğba Turgut, Hande Selvi Oztorun, Volkan Atmıs, Ahmet Yalcin, Sevgi Aras and Murat Varli
Background and aims. Diabetes Mellitus is a chronic systemic disease which has multiple complications and the presence of these complications affects the management of disease. It is also important to consider cognitive functions when managing the treatment of older diabetics. In this study, we aimed to make proposals for the appropriate drug choice to preserve cognitive functions in elderly diabetics.
Matherial and methods. A total of 270 older diabetic patients were reviewed. Possible risk factors of cognitive impairment were investigated. Correlation analysis was performed between MMSE and GDS, age, HbA1c, duration of diabetes.
Results. Sulfonylurea (adj. OR: 2.33, %95 CI: 1.11-4.90) and insulin treatment (adj. OR: 3.79, %95 CI: 1.56-9.21) were found associated with increased risk of cognitive impairment. In addition, there was a negative correlation between MMSE and GDS (r: -.129, p<0.05).
Conclusion. We suggest that insulin and sulfonylureas should be used with caution in those with cognitive impairment.