Short- and long-term relationships of serum ghrelin with changes in body composition and the metabolic syndrome in prepubescent obese children following two different weight loss programmes

Objectives Ghrelin has been proposed to be a regulator of energy balance, and its dysregulation may be important in obesity. The aims of this study were (i) to compare short‐ and long‐term changes in circulating ghrelin concentration after increasing energy expenditure vs. its changes after decreasing energy intake, (ii) to determine factors associated with changes in ghrelin level, and (iii) to assess relationships of ghrelin concentration with metabolic syndrome (MetS) in prepubescent obese children. Design Randomized controlled trial. Patients About 100 obese children aged 7–9 years. Measurements After baseline testing, children were randomly assigned to two interventional groups, either receiving dietary recommendations or engaging in physical training classes for 6 months. Ghrelin, insulin, leptin, fasting blood sugar, lipid profile and anthropometric indexes, as well as energy intake and expenditure were measured. Results Of the participants, 92 completed the 6‐month trial, and 87 returned for the 1‐year follow‐up. Except ghrelin level, other biochemical variables had no significant change at 12‐ vs. 6‐month follow‐up. In both groups, ghrelin showed a progressive increase in the periods of time with significant reduction of overweight and negative energy balance; while after the end of the trial, when children regained weight, it decreased toward baseline levels. Baseline ghrelin had strong negative correlation with measures of central obesity. The odds of having the MetS were 12% lower in the middle and 37% lower in the highest tertile of ghrelin level. As the number of MetS components increased, there was a progressive decrease in ghrelin and quantitative insulin sensitivity check index (QUICKI), with a progressive increase in serum insulin, HOMA‐R and leptin levels. Conclusions Ghrelin increases in response to overweight reduction and negative energy balance resulting from either an exercise intervention or reduction in food intake in prepubescent obese children. It is unlikely to regulate long‐term energy balance in young obese children.     

Congenital rubella syndrome in Iran

Background  

Congenital rubella syndrome (CRS) can be prevented with appropriate vaccination programs. The prevalence rates of rubella and CRS in Iran are unknown; therefore, the risk of exposure in pregnant women is not clear. The prevalence of CRS in the pre-vaccine period can be estimated by evaluating the proportion of children in the population with sensorineural hearing loss attributable to rubella.     

Effect of Weight Loss Induced by Intragastric Balloon Therapy on Cardiac Function in Morbidly Obese Individuals: A Pilot Study

Objective

The aim of the study was to investigate the effect of intragastric balloon therapy on left ventricular function and left ventricular mass in a cohort of morbidly obese patients.

Subjects and Methods

A prospective trial was performed in a cohort of 17 class II and class III morbidly obese individuals. The intragastric balloon was retained in the stomach for an average of 6 months. Conventional and tissue Doppler echocardiography were performed in all patients before and after the procedure.

Results

The mean age of the study participants was 36 ± 10 years (range: 18–55). The mean body mass index was significantly decreased following the intragastric balloon insertion procedure (44 ± 8 vs. 38 ± 5, p < 0.001). The left ventricular mass index and left atrial volume index were significantly decreased following the procedure (112 ± 21 vs. 93 ± 17, p = 0.001 and 20 ± 6 vs. 14 ± 5, p = 0.02, respectfully). In addition, the ratio of mitral peak early diastolic velocity to tissue Doppler-derived peak diastolic velocity and tissue Doppler echocardiography-derived left ventricular myocardial performance index were decreased significantly following the procedure (9.5 ± 1.9 vs. 7.7 ± 1.5, p = 0.002 and 0.57 ± 0.11 vs. 0.46 ± 0.06, p = 0.001, respectively).

Conclusions

Intragastric balloon therapy resulted in significant weight reduction in morbidly obese patients. This weight reduction was associated with improved left ventricular function.Key Words: Obesity, Intragastric balloon therapy, Echocardiography, Tissue Doppler     

Evaluation of Pulmonary and Extrapulmonary Tuberculosis in Immunocompetent Adults: A Retrospective Case Series Analysis

Objective

It was the aim of this study to evaluate the demographic factors and clinical features of extrapulmonary tuberculosis (EPTB) compared to those of pulmonary tuberculosis (PTB) among adult immunocompetent patients.

Subjects and Methods

A total of 427 patients with clinically, radiologically and histopathologically confirmed TB were enrolled in the study, in our clinic at a tertiary care hospital in Turkey, during a 5-year period (2007-2012). Patient data were obtained retrospectively. Among the 427 patients, 55 patients with both PTB and EPTB and who were using steroids or had taken immunosuppressive drugs were excluded from the study.

Results

Of the 372 patients, 227 (61%) were males and 168 (45.2%) had EPTB; 204 (54.8%) patients had PTB. The most frequent sites of EPTB were the lymph nodes (n = 45, 12.1%), pleura (n = 40, 10.7%) and brain (n = 7, 1.8%). The most common symptoms were cough (n = 174, 46.7%), night sweats (n = 127, 34.1%) and fever (n = 123, 33%). Compared to EPTB patients, PTB patients were less likely to have received Bacillus Calmette-Guérin vaccination (odds ratio 0.41, 95% confidence interval 0.2-0.63; p < 0.001). Eighty-one (48.2%) of the EPTB and 146 (71.6%) of the PTB patients were males. Pulmonary involvement was more common among men (n = 146, 71.6%) than among women (n = 58, 28.2%; p = 0.000).

Conclusion

There was a high incidence of EPTB in our study. Early diagnosis of EPTB is crucial for treatment, and atypical presentations of TB should be kept in mind for immunocompetent patients living in endemic areas. Females especially should be investigated for EPTB.Key Words: Tuberculosis, Extrapulmonary tuberculosis, Clinical features     

The feasibility of bipolar tissue sealer for appendix stump closure

Background: Appendiceal stump closure is a highly important step in laparoscopic appendectomy, especially for post-operative complications. The aim of this study is to compare the effects of suture ligation and bipolar tissue sealer techniques on burst pressure using flesh appendectomy specimens. Material and methods: Appendectomy specimens of 32 patients with grade I-II disease were included in the study. Perforated or necrotic appendices and specimens ineligible for pressure measurement were excluded from the study. Appendiceal stumps of 16 patients in group 1 were double-ligated with 2/0 polyglactin sutures, then appendectomy was performed between these sutures. In group 2, the management of the stump was performed through single ligation with polyglactin suture, followed by appendectomy using a bipolar tissue sealing device. Burst pressures were recorded for all specimens. Results: There were no differences between groups in terms of age and sex. There was no significant difference between the two groups in terms of burst pressure (p = 0.92). Also, no significant difference was found between groups in terms of localization of the perforation (p > 0.05). Conclusion: Bipolar tissue sealer achieves safe stump closure with satisfactory burst pressure values. Based on this, using bipolar tissue sealer for appendiceal stump closure in appendicitis may be safe and reliable.     

Endovascular treatment of intracerebral mycotic aneurysm before surgical treatment of infective endocarditis

Mycotic aneurysms are rarely seen in patients who have infective endocarditis, and the management of these patients remains controversial. We present the case of a patient who had infective endocarditis complicated by a mycotic aneurysm of the left middle cerebral artery. There was substantial mitral regurgitation, and Streptococcus viridans was isolated from the blood samples. Dysarthria appeared during the 4th week of the antibiotic therapy, but resolved completely 8 hours after onset. The left middle cerebral artery was embolized with platinum detachable coils. On the 7th day after the radiologic intervention, the native mitral valve was replaced with a 33-mm St. Jude Medical bi-leaflet mechanical mitral prosthesis. Most mycotic aneurysms show notable regression of symptoms with effective antibiotic treatment, and a very few may diminish in size. However it is impossible to predict the response of these aneurysms to therapy. To prevent the perioperative rupture of mycotic aneurysms and intracranial hemorrhage, priority should be given to endovascular interventions to treat cerebrovascular aneurysms in patients such as ours.     

Deep-sea hydrothermal vent bacteria related to human pathogenic Vibrio species

Vibrio species are both ubiquitous and abundant in marine coastal waters, estuaries, ocean sediment, and aquaculture settings worldwide. We report here the isolation, characterization, and genome sequence of a novel Vibrio species, Vibrio antiquarius, isolated from a mesophilic bacterial community associated with hydrothermal vents located along the East Pacific Rise, near the southwest coast of Mexico. Genomic and phenotypic analysis revealed V. antiquarius is closely related to pathogenic Vibrio species, namely Vibrio alginolyticus, Vibrio parahaemolyticus, Vibrio harveyi, and Vibrio vulnificus, but sufficiently divergent to warrant a separate species status. The V. antiquarius genome encodes genes and operons with ecological functions relevant to the environment conditions of the deep sea and also harbors factors known to be involved in human disease caused by freshwater, coastal, and brackish water vibrios. The presence of virulence factors in this deep-sea Vibrio species suggests a far more fundamental role of these factors for their bacterial host. Comparative genomics revealed a variety of genomic events that may have provided an important driving force in V. antiquarius evolution, facilitating response to environmental conditions of the deep sea.With more than 110 recognized species, the genus Vibrio comprises a diverse group of heterotrophic bacteria, of which many are known pathogens, causing disease in animals and humans (1, 2). Vibrio cholerae is the most notorious because it is the causative agent of cholera. Vibrio vulnificus and Vibrio parahaemolyticus cause severe illness in humans and are associated with consumption of contaminated seafood (3, 4). Vibrio harveyi (5), Vibrio anguillarum (6, 7), and V. parahaemolyticus (8) continue to cause substantial economic losses to the aquaculture industry worldwide.Vibrios demonstrate a wide range of niche specialization: for example, free-living, attached to biotic and abiotic surfaces, and resident in both estuarine and marine habitats (9). The deep sea constitutes the largest habitat of the biosphere that supports microbial communities across three domains of life and represents an environment where physiochemical parameters—such as low temperature, high salinity, and high pressure—modulate community structure (10, 11). Several studies have shown the presence of physiologically, metabolically, and phylogenetically diverse mesophilic microbial communities in the deep sea, including Vibrio species (12–15). Barotolerant Vibrio spp. have been isolated from deep-sea sediment and from the gut microflora of invertebrates and fish collected from a variety of deep-sea habitats, including hydrothermal vents (16, 17). For example, strains of Vibrio, Aeromonas, and Pseudomonas spp. were isolated from mud-water samples collected at a depth of 4,940 m, 150 miles east of Cape Canaveral, Florida (18). Several culture-dependent and -independent studies have confirmed the ubiquity of vibrios, and suggested Vibrio populations generally comprise approximately 1% (by molecular techniques) of the total bacterioplankton in estuaries (19), in contrast to culture-based studies demonstrating that vibrios can comprise up to 10% of culturable marine bacteria (20). Clearly, vibrios are ubiquitous and abundant in the aquatic environment on a global scale, including both seawater and sediment (19, 21–25), and repeatedly shown to be present in high densities in and on marine organisms, such as corals (26), fish (27–29), mollusks (30), seagrass, sponges, shrimp (28, 31), and zooplankton (16, 17, 28, 32, 33).During dives of the deep-sea submersibles Alvin and Nautile in 1999 along the East Pacific Rise, southwest of the Mexico coast, samples of water surrounding sulfide chimneys of a hydrothermal vent community were collected and four mesophilic bacterial isolates were cultured, which were subsequently tested for phenotypic traits, including growth on V. cholerae selective thiosulfate-citrate-bile-salts-sucrose (TCBS) agar (Oxoid). The sampling locations from where these four mesophilic bacteria were isolated are described in