Non-alcoholic fatty liver disease in subjects with type 2 diabetes mellitus and non-diabetics with special reference to insulin resistance and hepatic histopathological changes

AimsNon alcoholic fatty liver disease (NAFLD) includes simple steatosis and non alcoholic steatohepatitis (NASH). The present study was intended to evaluate insulin resistance (IR) in patients with NAFLD and correlate Insulin resistance [IR] with histopathological grades of liver involvement.Material and MethodsIt constituted of forty two consecutive patients (ultrasonographically established) with fatty liver admitted to our hospital. Ninteen were patients with Type 2 diabetes mellitus, 23 were normoglycemic and 12 age-matched healthy persons served as controls. IR was assessed by using HOMA-IR. Histopathological grading and staging of NAFLD was done as per Brunt system.ResultsDiabetics had significantly higher IR than both the other groups while non diabetics with NAFLD also had higher IR (p  < 001) than controls. There was no difference in the HDLc values between the three groups, whereas all other lipid parameters were higher in the patients. The IR was significantly higher 6.83(±2.51) in patients with grade 3 NASH as compared to patients with grade I changes 3.04(±1.58) (p < 0.05) irrespective of glycemic status. Similarly, the level of total cholesterol was significantly higher in patients with grade-3 NASH as compared to grade-1. Serum billirubin and liver enzymes (AST, ALT, ALP) were significantly higher in subjects with Grade 3 NASH when compared with Grade-1.ConclusionInsulin resistance and dyslipidemia rather than the glycemic status.were the determinant factors that had positive correlation with higher histopathological grades of NAFLD.     

Tobacco use and secondhand smoke exposure during pregnancy: an investigative survey of women in 9 developing nations

Objectives. We examined pregnant women''s use of cigarettes and other tobacco products and the exposure of pregnant women and their young children to secondhand smoke (SHS) in 9 nations in Latin America, Asia, and Africa.Methods. Face-to-face surveys were administered to 7961 pregnant women (more than 700 per site) between October 2004 and September 2005.Results. At all Latin American sites, pregnant women commonly reported that they had ever tried cigarette smoking (range: 78.3% [Uruguay] to 35.0% [Guatemala]). The highest levels of current smoking were found in Uruguay (18.3%), Argentina (10.3%), and Brazil (6.1%). Experimentation with smokeless tobacco occurred in the Democratic Republic of the Congo and India; one third of all respondents in Orissa, India, were current smokeless tobacco users. SHS exposure was common: between 91.6% (Pakistan) and 17.1% (Democratic Republic of the Congo) of pregnant women reported that smoking was permitted in their home.Conclusions. Pregnant women''s tobacco use and SHS exposure are current or emerging problems in several low- and middle-income nations, jeopardizing ongoing efforts to improve maternal and child health.Tobacco use is widely recognized as one of the leading threats to global health.¹ Historically, the prevalence of smoking among women in the developing world has been very low, in part because of strong cultural constraints against women''s smoking; approximately 50% of men in developing nations smoke cigarettes, compared with 9% of women.² Averting an increase in the prevalence of smoking among women in developing nations is widely recognized as a significant public health opportunity.^3,4Pregnant women are a priority population for tobacco control efforts because both cigarette smoking and smokeless tobacco use during pregnancy pose serious risks to fetal health. Smoking during pregnancy may cause preterm delivery, low birthweight, and sudden infant death syndrome; smokeless tobacco use during pregnancy has been associated with stillbirth, preterm birth, and reduced birthweight.^5–8 Maternal tobacco use is also likely to expose infants and children to secondhand smoke (SHS) and to provide a role model for children''s use of tobacco. Intervening during pregnancy is also important because of the health risks to the woman, who potentially has many years of remaining life. For cigarette smoking, these health risks include lung and other cancers, coronary heart disease and stroke, and chronic obstructive pulmonary disease; health risks from smokeless tobacco products include oral and pancreatic cancer.^9,10The US National Institute of Child Health and Human Development''s Global Network for Women''s and Children''s Health Research consists of 10 research units chosen for scientific merit that are focused on improving maternal and children''s health in the developing world. To determine whether pregnant women''s tobacco use and SHS exposure are emerging public health issues, the Global Network undertook an investigative survey of pregnant women''s knowledge, attitudes, and behaviors regarding tobacco use and SHS exposure. Here we report findings on pregnant women''s experimentation with and use of tobacco products, their perceptions of the social acceptability of tobacco use by women, and their and their young children''s exposure to SHS.     

Emergence of Lineage IV Peste des Petits Ruminants Virus in Ethiopia: Complete Genome Sequence of an Ethiopian Isolate 2010

Isolates of peste des petits ruminants virus (PPRV) can be segregated genetically into four lineages. For decades, lineages I–III have been reported across Africa whilst lineage IV has predominantly circulated across Asia. However, the lineage distribution is currently changing in Africa. Importantly, full genome sequence data for African field isolates have been lacking. Here, we announce the first complete genome sequence of a field isolate of peste des petits ruminants virus (PPRV) from East Africa. This isolate was derived from the intestine of a goat suffering from severe clinical disease during the 2010 outbreak in Ethiopia. The full genome sequence of this isolate, PPRV Ethiopia/2010, clusters genetically with other lineage IV isolates of PPRV, sharing high levels of sequence identity across the genome. Further, we have carried out a phylogenetic analysis of all of the available African partial N gene and F gene PPRV sequences to investigate the epidemiology of PPRV with a focus on the emergence of different lineages of PPRV in Africa.     

Does internal limiting membrane peeling in macular hole surgery improve reading vision?

PURPOSE: To document the effect of internal limiting membrane (ILM) peeling in macular hole closure and reading vision. METHOD: Fifty-four patients with idiopathic and traumatic macular hole underwent standard vitreous surgery and received either ILM peeling (n=25) or no ILM peeling (n=29). The hole closure, and Snellen acuity (distant and near) were recorded 12 weeks after surgery and statistically analysed. RESULTS: The macular hole closure rate was 96% (24 of 25) and 72.4% (21 of 29) with and without ILM peeling respectively (P = 0.028). Distant vision improvement of two or more lines was recorded in 64% (16 of 25) and 51.7% (15 of 29) eyes (P = 0.417) with and without ILM peeling respectively. Near vision improvement of two or more lines was seen in 68% (17 of 25) and 41.2% (12 of 29) eyes (P = 0.048) with and without ILM peeling respectively. CONCLUSION: ILM peeling in macular hole surgery improves the macular hole closure rate and reading vision.     

Effect of Cydonia oblonga Mill. fruit and leaf extracts on blood pressure and blood rheology in renal hypertensive rats

Ethnopharmacological relevance

Quince, Cydonia oblonga Mill. (COM), is used in traditional Uyghur medicine to treat or prevent cardiovascular diseases. Uyghur people have greater longevity and lower blood pressure than other central Asian populations. We therefore tested COM fruit and leaf extracts on blood pressure and rheology in renal hypertensive rats (RHR).

Materials and methods

Two-kidney, one-clip (2K1C) renal hypertensive rats were divided randomly into eleven groups: sham, model, and model treated with daily doses of 80 and 160 mg/kg aqueous or ethanol extracts of COM fruit or leaves, or 25 mg/kg captopril (n=10 per group), given orally once daily for 8 weeks. Blood pressure was measured before treatment and every 2 weeks thereafter. Blood rheology was tested after 8 weeks.

Results

Model rats had higher blood pressure than sham 8 weeks after the procedure (systolic blood pressure 193±7 vs. 138±8 mmHg, p<0.05). Those treated with captopril had decreased blood pressure within 2 weeks but that did not return to the level found in the sham group at 8 weeks (167±7, p<0.05 vs. model). With the COM extracts, the effect on blood pressure was notable after 4 weeks. At 8 weeks blood pressure was similar with captopril and with 160 mg ethanol leaf extract (166±4, p<0.05 vs. model), the most effective of the extracts. Model rats had higher blood viscosity and lower erythrocyte deformability than sham. Captopril had little effect on blood rheology; whereas COM extracts reduced whole blood viscosity and improved erythrocyte deformability to levels approaching those found in sham.

Conclusions

COM extracts have antihypertensive activity in renal hypertensive rats. The additional effect on rheology, compared to captopril, may convey added interest. Further studies of these effects in man appear warranted.     

Diagnostic accuracy of integrated 18F-FDG PET/CT for restaging patients with malignant germ cell tumours

Objective:

Evaluation of utility of fluorine-18 fludeoxyglucose (¹⁸F-FDG) positron emission tomography/CT (PET/CT) for restaging patients with primary malignant germ cell tumours (GCTs).

Methods:

Data of 92 patients (age, 31.94 ± 10.1 years; male/female, 86/6) with histopathologically confirmed malignant GCTs (gonadal, 88; mediastinal, 4; seminomatous, 47 and non-seminomatous, 45) who underwent ¹⁸F-FDG PET/CT for restaging (suspected recurrence/post-therapy evaluation) were retrospectively analysed. Two experienced nuclear medicine physicians reviewed the PET/CT images in consensus, qualitatively and semi-quantitatively [maximum standardized uptake value (SUVmax)]. Histopathology (if available) and clinical/imaging/biochemical follow-up (minimum of 6 months) were employed as the reference standard.

Results:

¹⁸F-FDG PET/CT was interpreted as positive in 59 and negative in 33 patients. Local disease was seen in 5, nodal disease in 50 and distant metastasis in 22 patients. PET/CT was true positive in 49, false positive in 10, true negative in 30 and false negative in 3 patients. ¹⁸F-FDG PET/CT showed sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 94.2%, 75.0%, 83.0%, 90.9% and 85.8% overall; 90.0%, 74.0%, 72.0%, 90.9% and 80.8% in seminomatous GCT; and 96.8%, 76.9%, 91.1%, 90.9% and 91.1% in non-seminomatous GCT, respectively. Difference in PET/CT accuracy for seminomatous and non-seminomatous GCTs was not significant (p = 0.263). PET/CT demonstrated disease in 13 patients with negative/equivocal conventional imaging findings and in 9 patients with normal tumour markers. No site- or histology-based difference was seen in SUVmax.

Conclusion:

¹⁸F-FDG PET/CT demonstrates high diagnostic accuracy for restaging patients with malignant GCTs. It has comparable diagnostic performance in both seminomatous and non-seminomatous malignant GCTs.

Advances in knowledge:

The present article demonstrates high diagnostic accuracy of ¹⁸F-FDG PET/CT for restaging both seminomatous and non-seminomatous malignant GCTs in a large patient population.Germ cell tumour (GCT) is the commonest malignancy in males aged between 20 and 35 years.¹ With cisplatin-based chemotherapy, high long-term cure rates can be achieved in patients with GCTs.² Traditionally, the follow-up of patients with GCT is carried out with clinical examination, measurement of serum tumour markers [alpha-fetoprotein (AFP), beta-human chorionic gonadotropin (β-HCG) and lactate dehydrogenase (LDH)], and with conventional imaging investigations such as CT or MRI.³ A major issue in the management of GCTs is post-chemotherapy residual masses, which harbour viable tumour cells in about 11–37% of cases.⁴ Unfortunately, CT or MRI cannot predict the histology of residual masses and has limited specificity in post-therapy setting.⁵Fluorine-18 fludeoxyglucose (¹⁸F-FDG) positron emission tomography (PET) improves the visualization of tumour cells by imaging their upregulated glucose metabolism. Based on this unique feature, ¹⁸F-FDG PET improves the differentiation of viable tumour from non-viable tissue.⁶ In many previous studies, ¹⁸F-FDG PET had been evaluated in patients with seminomatous and non-seminomatous GCTs with post-chemotherapy residual masses, demonstrating promising but variable results.^7–12 However, these studies had mostly employed PET alone, which suffers the limitations of having a lack of anatomical correlation, especially for detection of abdominopelvic disease, which can be overcome by the use of integrated PET/CT.¹³ Since few studies are available regarding the utility of integrated PET/CT in restaging of patients with GCTs, in the present study, this issue has been addressed. Also, since the utility of ¹⁸F-FDG PET/CT is limited for benign GCTs,¹¹ we only included patients with malignant GCTs in the present study.     

The prediction of abdominal surgical wound infection: the value of an enrichment broth for initial culture of operative parietal swabs

At the conclusion of 817 abdominal operations, duplicate swabs were taken from the subcutaneous tissues for microbiological examination; one swab was transported to the laboratory in Stuart's thioglycollate medium and the other immediately incubated in Robertson's cooked meat broth. The latter method resulted in significantly more isolations of potentially pathogenic bacteria than the former, (31% compared with 17%, P less than 0.001). Immediate culture in broth with subsequent subculture allowed more accurate prediction of patients at risk of wound infection; using this method we found a 1:3 likelihood of wound infection with a 5% chance of severe infection when a single pathogenic species was cultured, and a 1:2 likelihood of wound infection with a 10% chance of severe infection when two or more pathogenic species were cultured. Transport of swabs in thioglycollate medium, in contrast, detected fewer patients with parietal contamination and showed a 1:5 likelihood of wound infection when the swab was sterile and a 1:2 chance when one or more than one pathogenic species was cultured.