Initial experience of using intracardiac echocardiography (ICE) for guiding balloon mitral valvuloplasty (BMV)

Background and aimsBMV is an established treatment for rheumatic mitral valve stenosis. The procedure is historically guided by fluoroscopy, and the role of intracardiac echocardiogram (ICE) guidance is not well defined. We report our initial experience of using ICE to guide BMV procedures.MethodsDuring BMV procedure, ICE catheter was inserted into the right atrium from the right femoral vein, and the septal puncture was monitored by ICE, as well as positioning of the balloon in the mitral valve. Comparisons were made between ICE, transthoracic echocardiography (TTE), and catheterization derived hemodynamic measurements (cath).ResultsSeventeen patients with mitral stenosis underwent the procedure. The mean age was 44.4 ± 21 years. The mean MV area increased from 0.9 ± 0.1 cm² to 1.7 ± 0.2 cm², P < 0.0001 and the mean gradient decreased from 12.6 ± 5.8 mmHg to 4.9 ± 1.8 mmHg, P < 0.001. Atrial septum puncture and guidance of the balloon into the MV apparatus were obtained in all patients under ICE guidance. Severe MR developed in one patient and was readily detected by ICE. ICE derived gradient measurements were comparable to those obtained by TTE, and cath.ConclusionICE guidance of BMV is feasible, and useful in monitoring safe septal puncture, optimizing balloon positioning, and in detecting complications. The hemodynamic measurements obtained were comparable to those obtained by TTE, and cath.     

Assessment of the acute impact of normobaric hypoxia as a part of an intermittent hypoxic training on heart rate variability

AimTo assess the dynamics of ANS by means of heart rate variability (HRV) during and after acute exposure to normobaric hypoxia, representing a single session of an intermittent hypoxic training protocol.Material and methodsTwenty four healthy males aged 28.0 ± 7.2 (mean ± SD) breathed hypoxic air (FIO2 = 12.3 ± 1.5%) for one hour delivered via hypoxicator (AltiPro 8850 Summit+, Altitude Tech, Canada). Pulse oximetry and HRV were measured before, during and after the hypoxic exposure.ResultsAt the end of the hypoxic session all of the tested subjects had higher low frequency (lnLF) (6.9 ± 1.1 ms² vs. 7.5 ± 1.1 ms²; p = 0.042), LF/HF (1.5 ± 0.8 vs. 3.3 ± 2.8; p = 0.007) and standard deviation 2 of the Poincaré plot (SD2) (92.8 ± 140.0 ms vs. 120.2 ± 54.2 ms; p = 0.005) as well as increase in the Total power (7.7 ± 1.1 ms² vs. 8.1 ± 1.2 ms²; p = 0.032) and the Standard deviation of normal-to-normal interbeat intervals (SDNN) (57.3 ± 31.0 ms vs. 72.3 ± 41.1 ms; p = 0.024) but lower Sample entropy (SampEn) (1.6 ± 0.2 vs. 1.4 ± 0.2; p = 0.010). Immediately after the hypoxic exposure LF/HF lowered (3.3 ± 2.8 vs. 2.2 ± 1.8; p = 0.001) but lnHF significantly increased (6.6 ± 1.4 ms² vs. 7.1 ± 1.3 ms²; p = 0.020).ConclusionAcute normobaric hypoxia as a part of a single session of an intermittent hypoxic training protocol leads to changes in the activity of the ANS. The sympathetic tone prevails during hypoxic exposure and parasympathetic tone increases immediately after the hypoxic factor is withdrawn.     

Effects of hemodilution with a hemoglobin-based oxygen carrier (HBOC-201) on ischemia/reperfusion injury in a model of partial warm liver ischemia of the rat

BackgroundIschemia/reperfusion injury is an unavoidable complication in liver surgery and transplantation. Hemodilution with colloids can reduce postischemic injury but limits oxygen transport. Hemoglobin-based oxygen carriers have been evaluated as blood substitute and provide a plasma-derived oxygen transport. It was the aim of our study to evaluate the combined benefits of hemodilution with a better oxygen supply to reperfused liver tissue by the use of HBOC-201 (Hemopure^®).Material and methodsA model of partial warm liver ischemia in the rat was used. One group served as untreated control, the other groups were hemodiluted either with Ringer’s lactate, Dextran-70, HBOC-201 or a mixture of Dextran and HBOC-201. After reperfusion, intravital microscopy studies were done and tissue pO₂ levels and transaminases measured. Statistical analysis was done by one- and two-way ANOVA, followed by pairwise comparison.ResultsHemodilution with Ringer’s lactate did not show any improvement compared to the control group. Dextran and HBOC group were superior to the Ringer and control animals in all parameters studied. Leucocyte adherence in postsinusoidal venules improved from 569.03 ± 171.87 and 364.52 ± 167.32 in control and Ringer group to 131.68 ± 58.34 and 68.44 ± 20.31/mm² endothelium in Dextran and HBOC group (p < 0.001). Concerning tissue pO₂ levels, HBOC (23.4 ± 5.0 mmHg) proved to be superior to Dextran (7.9 ± 4.4 mmHg; p = 0.007).ConclusionHBOC was equivalent to Dextran in reducing I/R injury in the liver, but improved oxygenation of postreperfusion liver tissue.     

Non-invasive and invasive evaluation of aortic valve area in 100 patients with severe aortic valve stenosis: Comparison of cardiac computed tomography with ECHO (transesophageal/transthoracic) and catheter examination

BackgroundCurrent guidelines place emphasis on the determination of aortic valve area (AVA) for defining an appropriate treatment strategy. Invasive and non-invasive modalities are used to perform planimetric [transesophageal echocardiography (TEE) and cardiac multidetector computed tomography (MDCT)] and calculated [catheter examination (CE), transthoracic echocardiography (TTE)] AVA measurements.Purpose and methodsWe investigated 100 patients admitted to evaluate the AVA using cardiac MDCT (CT), TEE/TTE as well as invasive CE.ResultsIn all 100 patients we calculated a mean AVA of 0.79 ± 0.29 cm² (female 50/100, 0.70 ± 0.19 cm², male 0.9 ± 0.21 cm²) determined by all investigated examinations (mean ± SEM). AVA measurements determined by CT were significantly greater (0.86 ± 0.25 cm²) than those determined by CE: 0.75 ± 0.18 cm², p = 0.01. Echocardiographically determined AVA was comparable to CE (statistically not significant). Similar results were seen in all patients regardless of gender, presence of atrial fibrillation, and heart rate. We calculated a mean AVA for each patient and evaluated the variance of the AVA determined through investigated specific examinations as the bias. Overall, we found for CT 0.13 ± 0.1 cm², CE 0.13 ± 0.11 cm², TEE 0.16 ± 0.09 cm², and for TTE 0.16 ± 0.08 cm² a specific statistical non-significant variance. On subgroups: sinus rhythm, atrial fibrillation, females, males or combination, we found no further significant relevance for the specific variance.ConclusionOur data suggest the feasibility of cardiac MDCT to evaluate the correct AVA regardless of rhythm, heart rate, and sex. The planimetric concept to determine the AVA with CT displaces the “gold-standard” CE with respect to elucidating the potencies for complications, i.e. cerebral stroke. Regardless of CT's accessing of AVA measurement the TTE examination should remain the primary method of screening for aortic valve pathologies.     

Awareness of risk factors for type 2 diabetes in women with current and former gestational diabetes mellitus (GDM): Implications for future primary diabetes prevention

AimsTo assess the awareness of risk factors for type 2 diabetes and lifestyle changes that can decrease such risks in women with GDM.MethodsThe study comprised responses to health questionnaires by 319 women: 31 pregnant women with current GDM (CGDM), 88 women with previous GDM (PGDM), 100 pregnant women without DM (PWDM) and 100 non-pregnant women without DM (NPWDM). The CGDM group answered the questionnaires at the initiation and 4 weeks after participating in formal education on GDM. Two types of awareness scores (AS) were established. One AS was about the risks associated with GDM (GDMR), and the other was related to the awareness of lifestyle changes that can decrease the risks of type 2 diabetes (DM2R).ResultsThe PGDM group had the highest GDMR and DM2R scores (9.55 ± 2.66) (13.2 ± 2.26) compared with the other groups (CGDM 7.48 ± 3.14, NPWDM 6.10 ± 3.17, PWDM 2.89 ± 2.48) (p < 0.05) and (NPWDM 12.05 ± 2.73, CGDM 11.29 ± 2.45, PWDM 8.27 ± 4.14) (p < 0.05). The CGDM group increased the GDMR score from 7.48 ± 3.14 to 10.54 ± 2.57 (p < 0.0001) and the DM2R score from 11.29 ± 2.45 to 14.04 ± 1.26 (p < 0.001).ConclusionsWomen had limited awareness of risk factors for type 2 diabetes and lifestyle modifications that can decrease such risk of diabetes. AS were higher in women with current and previous GDM after receiving formal education.     

Correlation between creatinine clearance and Helicobacter pylori infection eradication with sequential and triple therapeutic regimens: A randomised clinical trial

Background and study aimsUraemic patients show susceptibility to gastrointestinal mucosal lesions and colonisation by Helicobacter pylori (HP). Antibiotic resistance constitutes a problem in treatment and bismuth preparations are toxic in uraemic patients. This study aimed to assess the correlation between creatinine clearance (CrCl) and eradication of HP infection with new sequential and standard triple therapeutic regimens.Patients and methodsA total of 120 HP-positive patients with renal function impairment and 60 control patients with HP infection were enrolled in this study. Patients were divided into four groups on the basis of CrCl and were randomly assigned to one of the two different regimens: A 14-day standard triple therapy with 20 mg omeprazole bid, 1000 mg amoxicillin bid and 500 mg clarithromycin bid and a new sequential regimen with 20 mg omeprazole bid and 1000 mg amoxicillin bid both for 14 days, 500 mg ciprofloxacin bid for the first 7 days and 200 mg furazolidone bid for the last 7 days. Doses of amoxicillin, clarithromycin and ciprofloxacin were reduced to 50% in the cases of CrCl <30 mg dl^?1.ResultsOne hundred and sixty two out of 180 HP-positive patients (54.3% male, 51.6 ± 12.1 years) completed treatment in the four groups and were studied. According to renal function they were classified into group A (n = 39), haemodialysis (HD) patients; group B (n = 37), CrCl <30 mg dl^?1 without HD; group C (n = 36), CrCl between 30 and 60 mg dl^?1; and group D (n = 50), control subjects with CrCl >90 mg dl^?1. HP was successfully eradicated in 77.7% of patients with standard triple therapy and in 81.4% of patients with the sequential therapy. There was no significant difference among the study groups in the rate of HP-infection eradication with both regimens.ConclusionHP eradication rates did not differ with both sequential and standard therapeutic regimens in uraemic and non-uraemic patients. We, therefore, prefer the standard triple therapy due to its simplicity and reported.     

Endoscopic band ligation of internal haemorrhoids versus stapled haemorrhoidopexy in patients with portal hypertension

Background and study aimPortal hypertension is common in Egypt as a sequela to the high prevalence of hepatitis C virus and bilharziasis. In portal hypertension internal haemorrhoids are frequently found. The aim of this work was to compare the outcome of endoscopic band ligation (EBL) of symptomatic internal haemorrhoids with that of stapled haemorrhoidopexy (SH) in Egyptian patients with portal hypertension.Patients and methodsIn this study, 26 portal hypertensive patients (with oesophageal and/or fundal varices) with a grade 2–4 internal haemorrhoids who had no coagulation disorders were randomised to treatment by EBL (13 patients) or SH (13 patients) after doing colonoscopy. Symptom scores of bleeding and prolapse were assessed before and after the intervention. Complications were recorded. Patients were followed up for 12 months.ResultsGoligher’s grades of internal haemorrhoids improved significantly (p = 0.018) 12 weeks after SH (from 2.9 ± 0.8 to 0.4 ± 0.5; p = 0.001) and after EBL (from 2.8 ± 0.8 to 1.1 ± 0.8; p = 0.001). Symptom (bleeding and prolapse) scores significantly improved 4 weeks after both EBL (from 1.6 ± 0.8 to 0.6 ± 0.8; p < 0.001 and from 1.6 ± 0.9 to 0.5 ± 0.5; p = 0.002, respectively) and SH (from 1.8 ± 0.8 to 0.2 ± 0.4; p = 0.002 and from 1.5 ± 0.9 to 0.2 ± 0.4; p = 0.001, respectively). The differences after 4 weeks between EBL and SH were not significant (p = 0.168 and p = 0.225). Pain requiring analgesics occurred in five patients (38.5%) after EBL, compared with six (46.2%) after SH (p = 0.691). Minimal bleeding occurred in two patients (15.4%) after EBL but not with SH; urinary retention was observed in one patient after EBL compared with two after SH; and anal fissures were observed in one patient after EBL. During 1-year follow-up, increased frequency of stool occurred in one patient after EBL. Recurrence of symptoms was observed in three patients after EBL and in one after SH.ConclusionFor portal hypertensive patients with internal haemorrhoids and without coagulation disorders SH seems to be superior to EBL. However further studies are needed to evaluate EBL in different grades of cirrhosis.     

Study of the effects of transoral gastroplasty on insulin sensitivity and secretion in obese subjects

Background and aimsTransoral gastroplasty (TOGA) recently emerged as a new, feasible and relatively safe technique for the surgical treatment of obesity. However, so far there are no data on the effects on insulin sensitivity in the literature. Our aim is to evaluate the effect of TOGA on insulin sensitivity and secretion.Methods and resultsNine glucose normo-tolerant obese subjects (age:41 ± 6 years; BMI:42.49 ± 1.03 kg/m²) were studied. Fat-free mass (FM) and fat mass (FM) were assessed by bioelectrical impedance; plasma glucose, insulin, and C-peptide were measured during an oral glucose tolerance test (OGTT) before and 3 months after the operation. Insulin sensitivity was calculated using the oral-glucose insulin-sensitivity index, and insulin secretion by C-peptide deconvolution.Three months after surgery, a significant (P = 0.008) reduction of BMI to 35.65 ± 0.65 kg/m², with a decrease of FM and FFM from 57.22 ± 2.19 to 41.46 ± 3.02 kg (P = 0.008) and from 59.52 ± 1.36 to 56.67 ± 1.10 kg (P = 0.048) respectively, was observed. Insulinemia was significantly reduced at fast and at 120 min after OGTT; in contrast, no significant change in glucose concentration was observed. Insulin sensitivity significantly increased (348.45 ± 20.08 vs. 421.18 ± 20.84 ml/min/m², P = 0.038) and the incremental area of insulin secretion rate (total ISR) significantly decreased (from 235.05 ± 27.50 to 124.77 ± 14.50 nmol/min/m², P = 0.021). Total ISR correlated with weight, BMI and FM (r = 0.522, P = 0.028; r = 0.541, P = 0.020; r = 0.463, P = 0.049, respectively). BMI represented the most powerful predictor of ISR decrease (R² = 0.541, P = 0.020).ConclusionTransoral gastroplasty allows a significant weight loss 3 months after the intervention as well as an amelioration of insulin sensitivity with subsequent reduction of the insulin secretion.     

The impact of commissural morphology on clinical outcome in patients undergoing percutaneous balloon mitral valvuloplasty

AimWe aimed to evaluate the prognostic value of commissural morphology on immediate and short term outcome after Percutaneous balloon mitral valvuloplasty (PBMV).MethodsThe study included 30 patients with symptomatic mitral stenosis (MS) scheduled for PBMV with these exclusion criteria: left atrial thrombi, High echocardiography score, Moderate to severe mitral regurgitation (MR), Atrial fibrillation (AF) or Calcification. After PBMV, they were randomized into 2 groups: Group I: 12 patients with only opened one commissure and group II: 18 patients with bilateral opened commissures.ResultsFollowing PBMV, the mean mitral valve area (MVA) increased from 0.94 ± 0.19 to 1.86 ± 0.27 cm² in group I & from 0.91 ± 0.18 to 2.29 ± 0.33 cm² in group II (p = 0.001). The mean transmitral gradient (MG) decreased from 21.83 ± 4.1 to 8.08 ± 2.9 mmHg in group I and from 18.28 ± 5 to 5.2 ± 1.76 mmHg in group II (p = 0.003). The MVA was 1.85 ± 0.23 cm² in group I and 2.25 ± 0.31 cm² in group II (p = 0.001) and MG was 8.09 ± 2.90 mmHg in group I and 5.47 ± 1.79 mmHg in group II (p = 0.001). Three month follow-up: there was no patient developed AF, embolization or severe MR. Also, there was no mortality, redo, or surgery.ConclusionWe concluded that degree of commissural opening and MVA are closely related. The complete bilateral commissural opening is associated with better sustained MVA and functional status. Thus, evaluation of the degree of commissural opening can be considered as a complementary measure of the procedural success in PBMV.     

A structured,group-based diabetes self-management education (DSME) programme for people,families and whanau with type 2 diabetes (T2DM) in New Zealand: An observational study

BackgroundGroup-based diabetes self-management education (DSME) programmes have been shown to be effective. A programme tailored for the unique social and ethnic environment of New Zealand (NZ) was developed using concepts from internationally developed programmes.AimTo assess the effectiveness of a 6 week New Zealand specific DSME programme.MethodsIn this observational study people with type 2 diabetes (aged 18–80 years) from diverse cultural backgrounds were recruited from primary care. Seventeen groups of six education sessions were run. Clinical data were collected from primary care at baseline, 3, 6 and 9 months. Participants also completed a self-administered questionnaire on diabetes knowledge, and self-management behaviours.Results107 participants, mean age 56.7 ± 11.3 years and mean duration of diabetes 7.5 ± 7 years (NZ European (44%), Maori (24%), Pacific (16%) and Indian (16%)), were enrolled. Confidence in self-managing diabetes, regular examination of feet, physical activity levels and smoking rates all improved. Glycaemic control improved between baseline and 6 months (HbA_1C 64.9 ± 20.0 mmol/mol to 59.9 ± 13.9 mmol/mol (p < 0.05) (baseline 8.07% ± 1.80, 6 months 7.62% ± 1.25)), but was no different to baseline at 9 months. Systolic BP reduced from 131.9 ± 16.4 to 127.4 ± 18.2 mmHg (p < 0.05) at 6 months, but increased to baseline levels by 9 months. Diastolic BP, triglycerides and urine microalbumin:creatinine ratio were significantly reduced at 3, 6 and 9 months.ConclusionA group-based DSME programme designed specifically for the NZ population was effective at improving aspects of diabetes care at 6 months. The attenuation of these improvements after 6 months suggests a refresher course at that time may be beneficial.     

Maintenance ribavirin monotherapy delays fibrosis progression in liver transplant recipients with recurrent hepatitis C at high risk of progression

BackgroundFibrosis in liver transplant recipients with recurrent HCV is fast, yet, different patterns of progression are recognized.AimsTo investigate histological findings associated with maintenance ribavirin monotherapy in patients with recurrent HCV transplanted ≥4 years earlier.Methods14 recipients at high risk of progression (fibrosis progression rate >0.33 units/year and/or persistently elevated ALT) were assigned to receive ribavirin for 3 years. 11 patients at lower risk of progression (FPR ≤0.33 units/year and normal ALT) as controls. Biopsies were obtained yearly since transplant and 7 consecutive biopsies were evaluated.ResultsImproved necroinflammation (reduction ≥2 grading) was observed in 7 treated with ribavirin and 3 untreated patients, while 1 and 3 patients worsened respectively. Fibrosis improved (reduction >1 staging) in 2 ribavirin-treated patients, unchanged in 10 and worsened (increase ≥1 staging) in 2. Fibrosis progression decreased from 0.48 ± 0.27 observed during the 3-year pre-treatment period to 0.04 ± 0.31 units/year (p = 0.003) during the 3 years of ribavirin. Among untreated fibrosis remained unchanged in 1 and worsened in 10 (p < 0.001), yearly fibrosis progression rate increasing from 0.15 ± 0.17 units/year to 0.42 ± 0.39 units/year (p = 0.10).ConclusionsMaintenance ribavirin monotherapy delays fibrosis progression in high risk patients, offering an alternative strategy for those failing to respond to conventional treatment.     

Effects of coffee consumption in chronic hepatitis C: A randomized controlled trial

BackgroundCoffee is associated with a reduced risk of hepatocellular carcinoma in patients with chronic C hepatitis. This prospective trial was aimed at assessing the mechanisms underlying coffee-related protective effects.MethodsForty patients with chronic hepatitis C were randomized into two groups: the first consumed 4 cups of coffee/day for 30 days, while the second remained coffee “abstinent”. At day 30, the groups were switched over for a second month.ResultsAt baseline, aspartate aminotransferase and alanine aminotransferase were lower in patients drinking 3–5 (Group B) than 0–2 cups/day (Group A) (56 ± 6 vs 74 ± 11/60 ± 3 vs 73 ± 7 U/L p = 0.05/p = 0.04, respectively). HCV-RNA levels were significantly higher in Group B [(6.2 ± 1.5) × 10⁵ vs (3.9 ± 1.0) × 10⁵ UI/mL, p = 0.05]. During coffee intake, 8-hydroxydeoxyguanosine and collagen levels were significantly lower than during abstinence (15 ± 3 vs 44 ± 16 8-hydroxydeoxyguanosine/10⁵ deoxyguanosine, p = 0.05 and 56 ± 9 vs 86 ± 21 ng/mL, p = 0.04). Telomere length was significantly higher in patients during coffee intake (0.68 ± 0.06 vs 0.48 ± 0.04 Arbitrary Units, p = 0.006). Telomere length and 8-hydroxydeoxyguanosine were inversely correlated.ConclusionIn chronic hepatitis C coffee consumption induces a reduction in oxidative damage, correlated with increased telomere length and apoptosis, with lower collagen synthesis, factors that probably mediate the protection exerted by coffee with respect to disease progression.     

Vascular responsiveness in patients with chronic obstructive pulmonary disease (COPD)

BackgroundIschemic heart disease and peripheral vascular diseases are prevalent in COPD and it is estimated that any 10% decrease in forced expiratory volume in 1 second (FEV1) is associated with 30% increased cardiovascular risk of death. Endothelial dysfunction may be one of the mechanistic pathways that link between COPD and cardiovascular mortality. Our aim was to study the vascular reactivity of patients with stable COPD and to try to correlate endothelial dysfunction, vascular reactivity and functional capacity of these patients that eventually may lead to cardiovascular mortality.MethodsThis was a prospective study. Twenty-three consecutive ambulatory COPD patients were enrolled. All were smoking men, aged 64.4 ± 8.4 years. Twenty-two healthy volunteers aged 44.7 ± 11.7 years, BMI of 25.2 ± 4.2, height of 172 ± 8 cm served as the control group. Vascular studies included endothelial function and ankle brachial index.ResultsBaseline diameter of the brachial artery was larger in COPD patients compared with controls. The absolute change in diameter post hyperemia was significantly less in patients (0.004 ± 0.02 cm vs. 0.05 ± 0.02 cm, p < 0.001) and COPD patients responded to hyperemia by constriction instead of dilatation (FMD% was − 0.6 ± 6.3% in patients vs. 15.6 ± 7.6% in controls, p < 0.001). There was no difference in ABI in patients and controls (0.95 ± 0.26 vs. 1.06 ± 0.16, p = 0.07).DiscussionWe found that patients with COPD have dilated arteries, have impaired ability to respond to high shear stress that triggers nitric oxide dependent flow mediated dilatation, and have also impaired ability to function — represented by the poor 6 minute walk test.     

The lack of influence of food and local alcoholic brew on the blood level of Mectizan® (ivermectin)

There is concern that extraneous factors, such as food and drink, may alter the pharmacodynamics of Mectizan^® (ivermectin) in patients receiving this important anti-parasitic drug, and thus might put such individuals in danger of serious adverse events. The effects of a common local alcohol-containing beverage and a local food on plasma levels of ivermectin were studied in Sudanese volunteers after administration of the standard dose used in mass drug administration programs for onchocerciasis and filariasis.Plasma levels of ivermectin at various time points (0–48 h) after administration of ivermectin were ascertained by HPLC assay in ten volunteers given 150 μg kg⁻¹ ivermectin together with either a local sorghum-based food (‘assida’), or a locally brewed alcoholic beverage (‘arangi’ made from sorghum grain) or in those who were fasting. Maximum mean (±SD) plasma levels of ivermectin (67 ± 49 ng ml⁻¹) were reached within 2 h in fasting patients, and had dropped to 26 ± 20 ng ml⁻¹ after 30 h. The coadministration of local food or alcoholic beverage did not cause an increase in ivermectin plasma levels above those observed in people who were fasting. However, at 2 h after ivermectin administration, patients given alcohol had significantly lower plasma ivermectin levels than fed patients or fasting patients. There were no significant differences among treatments for AUC_0–30, C_max, or t_max, and so the coadministration of local food or alcoholic beverage did not cause any change in pharmacokinetic parameters of ivermectin in the plasma in comparison with fasting. None of the measured levels of plasma ivermectin were greater than those reported in previous studies with this compound.These findings do not support the hypothesis that acute intake of alcohol is an important factor in the development of the serious adverse reactions that can occur during the treatment of loaisis patients with ivermectin (Mectizan^®).     

Effects of levothyroxine on growth hormone (gh) sensitivity in children with idiopathic short stature

BackgroundThe possible relationship between the circulating concentrations of T4 and GH sensitivity has not been elucidated.ObjectiveThe aim of this study is to evaluate the effect of levothyroxine supplementation on GH sensitivity in prepubertal boys with idiopathic short stature (ISS).MethodsWe selected 28 prepubertal boys with ISS (mean age 8.2 ± 0.5 years) and free T4 (Ft4) concentrations between the 3rd and the 25th percentiles (Ft4: 0.8–1.5 ng/dl). They were randomly divided into two groups: Group A received thyroid supplementation (1–3 μg/kg/day) for 120 days, and Group B received placebo for the same period. To evaluate GH sensitivity, an IGF-I generation test (GH: 33 μg/kg/day sc for 3 days) was performed in both groups: under basal conditions, and after 120 days of levothyroxine supplementation (or placebo).ResultsAfter thyroid supplementation, Group A had higher Ft4 concentrations compared with Group B (2.14 ± 0.06 vs 1.48 ± 0.06 ng/dl, p = 0.01), their growth velocity was significantly higher (2.3 ± 0.1 vs 1.5 ± 0.2 cm/4 months), and they exhibited a greater increase in IGF-I after GH administration (Group A: 32.5 ± 3.8% vs Group B 17.3 ± 2.6%).ConclusionSupplementation with levothyroxine for 120 days promotes an increase in growth velocity, and a greater IGF-I response to short-term GH administration in prepubertal boys with ISS and low-normal thyroid hormone concentrations.     

Rigidité artérielle mesurée par pOpmètre® chez les patients à risque cardiovasculaire,lien aux plaques d’athérome carotidien

PurposeAortic stiffness is a functional and structural consequence of ageing and arteriosclerosis. Regional arterial stiffness can be easily evaluated using pOpmetre^® (Axelife SAS, France). This new technique assesses the pulse wave transit time (TT) between the finger (TTf) and the toe (TTt). Based on height chart, regional pulse wave velocity (PWV) between the toe and the finger can be estimated (PWVtf). pOpscore^® index is also calculated as the ratio between PWVtoe and PWVfinger and can be considered as a peripheral vascular stiffness index. The aim of the study was to evaluate the relationship between pOpmetre^® indices and the presence of carotid plaques in a population with cardiovascular risk factors.MethodsIn 77 consecutive patients recruited for a vascular screening for atherosclerosis (46 men aged 54 ± 2 years; 31 women aged 49 ± 3 years; ns), the difference between TTt and TTf (called Dt-f), the regional pulse wave velocity between the toe and the finger (PWVtf = constant × height/Dt-f m/s) and pOpscore^® were measured by pOpmetre^®. Presence of carotid plaques was assessed using ultrasound imaging. The local aortic stiffness (AoStiff) was evaluated by the Physioflow^® system.ResultsNo difference was found between patients with or without carotid plaques (n = 25 versus 52) for Ankle-Brachial Pressure Index (ABPI: 1.15 ± 0.04 versus 1.12 ± 0.03), nor for diastolic or systolic blood pressure (87 ± 3 versus 82 ± 2; 137 ± 3 versus 132 ± 2 mmHg). The first group was older than the second (59 ± 2 versus 49 ± 2 years, P < 0.002) with a larger intimae media thickness (0.69 ± 0.02 versus 0.63 ± 0.01 mm, P < 0.004), a higher AoStiff (10.4 ± 0.7 versus 8.2 ± 0.5 m/s, P < 0.02), and PWVtf (14.3 ± 1.0 versus 10.7 ± 0.7 m/s, P < 0.004) and a shorter Dt-f (57.9 ± 5.1 versus 73.5 ± 3.5 ms, P < 0.01). PWVtf (r² = 0.49, P < 0.0001) and Dt-f (r² = 0.54, P < 0.0001) correlated with age. A significant difference in pOpscore^® index was observed between both groups (1.51 ± 0.3 versus 1.41 ± 0.2, P < 0.006).ConclusionOur results show a significant arterial stiffness indices measured by pOpmetre^® in patients with and without carotid plaques.     

Glucose flux in controlled hyperglycaemia before and after oral glucose ingestion in men with mild type 2 diabetes

AimsThis study aimed to determine how insufficiently suppressed endogenous glucose production vs. reduced peripheral glucose uptake contribute to postprandial hyperglycaemia in type 2 diabetes (T2D).MethodsEight men with T2D (age: 52 ± 7 years; BMI: 26.6 ± 2.3 kg/m²; fasting glycaemia: 7.1 ± 1.5 mmol/L) were compared with eight non-diabetic controls (age: 51 ± 5 years; BMI: 24.6 ± 2.9 kg/m²; fasting glycaemia: 4.9 ± 0.4 mmol/L). Their glucose turnover rates and hepatic glucose cycles were measured by monitoring [2H7]glucose infusion, with m+7 and m+6 enrichment, 3 h before and 4 h after the ingestion of [6,6-2H2]-labelled glucose, while maintaining glycaemia at 10 mmol/L using the pancreatic clamp technique.ResultsOf the 700 mg/kg oral glucose load, 71% appeared in the systemic circulation of the T2D patients vs. 63% in the controls (NS). Endogenous glucose production and hepatic glucose cycles did not differ from normal either before or after oral glucose ingestion, while peripheral glucose uptake was reduced by 40% in the T2D group both before (P < 0.01) and after (P < 0.05) ingestion of oral glucose.ConclusionWhen T2D patients were compared with non-diabetic subjects with similarly controlled levels of hyperglycaemia after oral glucose ingestion, they essentially differed only in peripheral glucose uptake, whereas endogenous glucose production was apparently unaltered.     

Changes in liver stiffness using acoustic radiation force impulse imaging in patients with obstructive cholestasis and cholangitis

BackgroundAcoustic radiation force impulse imaging is used to assess stages of liver fibrosis. The aim of our study was to evaluate liver stiffness changes in patients with biliary obstruction with or without sclerosing cholangitis after biliary drainage.MethodsA total of 71 patients were enrolled in this prospective study (cohort N = 51, control group N = 20); 51 patients with obstructive cholestasis, indicated for endoscopic retrograde cholangiography, received stiffness measurement by acoustic radiation force impulse imaging before and 1–2 days after endoscopic retrograde cholangiography. Seventeen patients with obstructive cholestasis had primary or secondary sclerosing cholangitis. Forty one patients had a follow-up acoustic radiation force impulse imaging measurement after 3.0 ± 9.31 weeks.ResultsIn all patients with obstructive cholestasis, stiffness decreased significantly after biliary drainage (p < 0.001). The main decrease was observed within 2 days after endoscopic retrograde cholangiography (1.92–1.57 m/s, p < 0.001) and correlated with the decrease of bilirubin and alkaline phosphatase (p = 0.04 and p = 0.002, respectively). In patients with sclerosing cholangitis, the initial decrease of stiffness after biliary drainage was weaker than in those without (2.1–1.85 m/s vs. 1.81–1.43 m/s, p = 0.016).ConclusionAcoustic radiation force impulse imaging elastography shows that liver stiffness is increased by biliary obstruction, and decreases after endoscopic retrograde cholangiography irrespective of the aetiology. In patients with sclerosing cholangitis the reduction in stiffness after biliary drainage is impaired.     

Non-functioning pituitary adenoma underwent surgery: A multicenter retrospective study over the last four decades (1977–2015)

ObjectiveTo assess clinical features, diagnostic procedures, therapies and outcomes in patients with clinically non-functioning pituitary adenomas (NFPAs) surgically treated over the last four decades.Design and methodsA multicenter retrospective study in NFPA patients periodically followed up in specialized neuroendocrinology units who underwent surgery in the period 1977–2015 was performed.ResultsA total of 131 patients were studied [66 women (50.4%); mean age 52.6 ± 14.8 years (range, 15–82)]. Median diameter of the adenoma was 2.6 cm (interquartile range, 2.0–3.1). The most frequently type of surgery used was endoscopic endonasal surgery (58.5%) followed by microscopic transsphenoidal surgery (37.4%). Radiation therapy was used in 19 patients (14.5%). Ki-67 labeling index performed in 54 patients was ≤ 2% in 70% samples. After a median follow-up time of 57 months (25 to 128 months), tumor diameter significantly decreased to 0.9 cm (0–1.8 cm), p < 0.001. Multivariant analysis showed that endoscopic endonasal surgery (HR 2.74, 1.06–6.87, p = 0.036) and radiotherapy (HR 0.04, 0.02–0.65, p = 0.024) behaved as positive and negative predictors, respectively, of tumor absence in the follow-up. Endoscopic endonasal surgery (HR 6.71, 1.45–31.05, p = 0.015) was the only positive predictor for complete cure in the follow-up.ConclusionNFPAs surgically treated in Spain are usually macroadenomas diagnosed around the sixth decade of life with no sex predilection. Type of surgery is associated with clinical outcome. Endoscopic endonasal surgery behaves as a positive predictor for the absence of tumor imaging and complete cure in the follow up.     

Plateletcrit and red cell distribution width are independent predictors of the slow coronary flow phenomenon

Background and purposeEndothelial dysfunction may play a role in the pathogenesis of the slow coronary flow (SCF) phenomenon. A detailed examination of blood cellular components has not been performed for this condition. We investigated the relationship between SCF and whole blood cell counts.MethodRecords of 17,315 patients who underwent coronary angiography between January 2006 and December 2012 were evaluated retrospectively. A total of 146 patients with SCF were compared with 148 patients with normal coronary arteries according to demographic data, complete blood count, and biochemical parameters.ResultsThe following parameters were significantly higher in SCF patients than in patients with normal coronary arteries: percentage of smokers (36.3% vs. 25%, p = 0.036), body mass index (26.69 ± 2.84 vs. 26.07 ± 3.15, p = 0.049), white blood cells (WBCs) (7.52 ± 1.43 × 10³ mm^–3 vs. 7.01 ± 1.42 × 10³ mm^–3, p = 0.002), red cell distribution width (RDW) (13.68 ± 1.42% vs. 13.15 ± 1.13%, p < 0.001), platelets (250.29 ± 50.96 × 10³ mm^–3 vs. 226.10 ± 38.02 × 10³ mm^–3, p < 0.001), plateletcrit (PCT) (0.214 ± 0.40% vs. 0.184 ± 0.29%, p < 0.001), mean platelet volume (8.63 ± 1.10 fL vs. 8.22 ± 0.83 fL, p < 0.001), platelet distribution width (PDW) (16.58 ± 0.76% vs. 16.45 ± 0.57%, p = 0.028), and neutrophils (4.44 ± 1.25 × 10³ mm^–3 vs. 4.12 ± 1.24 × 10³ mm^–3, p = 0.029). Positive PCT values [odds ratio (OR), 4.165; 95% confidence interval (CI), 2.493–6.959; p < 0.001) and RDW (OR, 1.304; 95% CI, 1.034–1.645; p = 0.025) were independent predictors of SCF.ConclusionAlthough within the normal range, the increased numbers of WBCs and neutrophils in patients with SCF suggest that SCF may be a subclinical inflammatory condition. Furthermore, increased RDW and PDW in SCF patients may cause microvascular blood flow resistance due to impaired cell deformability. The PCT provides reliable data regarding total platelet mass and may be a useful predictor of SCF.