The impact of laryngopharyngeal reflux on patient-reported quality of life

OBJECTIVES/HYPOTHESIS: The objectives were to assess patient-reported outcomes, specifically, the health-related quality of life of patients with laryngopharyngeal reflux, and to compare those reported levels with the health-related quality of life of patients with gastroesophageal reflux disease and a general population. STUDY DESIGN: Prospective study. METHODS: As part of a prospective study to validate a health-related quality of life instrument for laryngopharyngeal reflux, patient-reported data were collected before the initiation of therapy. Use of the Short Form-36 (SF-36), a generic instrument, allowed the health-related quality of life of the patients with laryngopharyngeal reflux to be compared with benchmarks existing for patients with gastroesophageal reflux disease and a general U.S. population. RESULTS: The 117 patients with laryngopharyngeal reflux often reported multiple symptoms, most frequently, chronic throat-clearing (85.5%), globus (82.1%), and hoarseness (80.3%). Their mean health-related quality of life was statistically significantly worse than that of a general U.S. population in seven of the eight SF-36 domains. The most dramatic differences between patients with laryngopharyngeal reflux and the general population were in social functioning and bodily pain (P <.001). Mean scores for patients with laryngopharyngeal reflux were significantly lower than those for patients with gastroesophageal reflux disease in social functioning (P <.001) and vitality (P =.0017). In five of the six remaining domains, patients with laryngopharyngeal reflux reported lower mean scores than did patients with gastroesophageal reflux disease, but those differences were not statistically significant. CONCLUSION: The study's assessment of health-related quality of life suggests that laryngopharyngeal reflux has a significant negative impact on the lives of patients. Although its impact is similar in some respects to that of gastroesophageal reflux disease, laryngopharyngeal reflux has a more significant impact on patients' social functioning and vitality.     

Enhancement of dissolution and oral bioavailability of lacidipine via pluronic P123/F127 mixed polymeric micelles: formulation,optimization using central composite design and in vivo bioavailability study

This study aims at preparing and optimizing lacidipine (LCDP) polymeric micelles using thin film hydration technique in order to overcome LCDP solubility-limited oral bioavailability. A two-factor three-level central composite face-centered design (CCFD) was employed to optimize the formulation variables to obtain LCDP polymeric micelles of high entrapment efficiency and small and uniform particle size (PS). Formulation variables were: Pluronic to drug ratio (A) and Pluronic P123 percentage (B). LCDP polymeric micelles were assessed for entrapment efficiency (EE%), PS and polydispersity index (PDI). The formula with the highest desirability (0.959) was chosen as the optimized formula. The values of the formulation variables (A and B) in the optimized polymeric micelles formula were 45% and 80%, respectively. Optimum LCDP polymeric micelles had entrapment efficiency of 99.23%, PS of 21.08?nm and PDI of 0.11. Optimum LCDP polymeric micelles formula was physically characterized using transmission electron microscopy. LCDP polymeric micelles showed saturation solubility approximately 450 times that of raw LCDP in addition to significantly enhanced dissolution rate. Bioavailability study of optimum LCDP polymeric micelles formula in rabbits revealed a 6.85-fold increase in LCDP bioavailability compared to LCDP oral suspension.     

Evaluation of Nutritional Status Post Laparoscopic Sleeve Gastrectomy—5-Year Outcomes

Introduction

Obesity is considered a public health problem and has led to advancements in bariatric surgery. Laparoscopic sleeve gastrectomy (LSG) had become the most performed procedure worldwide; however, its consequences on nutritional status in the short and long term are of concern.

Methods

A retrospective analysis of medical records and bariatric database of patients who underwent LSG from October 2008–September 2015 at Al-Amiri Hospital, Kuwait, was performed. Data regarding nutritional status along with demographic data were collected over a 5-year follow-up period.

Results

One thousand seven hundred ninety-three patients comprising of 74% females and 26% males were included. The greatest % total body weight loss (%TBWL) was at 18 months post-LSG (33%), corresponding to a % excess weight loss (%EWL) of 73.8%. With regard to nutritional status, vitamin B1 showed a significant drop at 3–5 years post-op in comparison to pre-op value, but stayed within the normal range throughout the study. Red blood cells count, hemoglobin, and hematocrit also showed a significant drop starting from 6 months post-op until the fifth year of follow-up. On the other hand, vitamins B6 and B12 showed a significant increase at 6 months post-op and decreased afterwards, but did not reach pre-op values. Vitamin D also showed a significant increase throughout the study period from deficient value at the pre-op time, but remained insufficient. Albumin, transferrin, folate, ferritin, iron, and vitamin B2 showed no significant changes at 5 years post-LSG compared to pre-op values.

Conclusion

Little is known about the nutritional status and optimal nutritional care plan post-LSG, especially in the longer term. Nutritional deficiencies were prevalent prior and post-LSG. Some of the nutritional parameters improved and even reached the abnormal high level post-LSG. These observations highlight the importance of pre- and post-operative nutritional assessment and tailored supplementation to ensure optimal nutritional status.

     

Effect of Echinacea alone or in combination with silymarin in the carbon-tetrachloride model of hepatotoxicity

Echinacea preparations are widely used in the prevention or treatment of upper respiratory tract infections. The present study aimed to investigate the effect of a standardized Echinacea extract in experimentally induced liver toxicity and whether this herb would have a modulating effect on the silymarin-induced hepatoprotection in rats. Liver damage was induced by the administration of carbon tetrachloride (CCl₄). Echinacea extract (18 or 36?mg/kg) alone or combined with silymarin (25?mg/kg), silymarin only (25?mg/kg), or saline (control) was given once daily orally simultaneously with CCl₄ and for 1?week thereafter. Serum alanine aminotransferase (ALT) or aspartate aminotransferase were not significantly changed by treatment with Echinacea, but alkaline phosphatase (ALP) in serum decreased by 23.6% by the extract at 36?mg/kg. Silymarin given in combination with either dose of Echinacea resulted in 34.9% and 57.8% reduction in AST, 42.7% and 58% reduction in ALT and 41% and 60% reduction in ALP, compared with CCl₄ control group. Silymarin alone reduced ALT, AST, and ALP levels by 58.8%, 61.2%, and 62.2%, respectively. Histopathological examination revealed a mild decrease in degenerated hepatocytes after treatment with 36?mg/kg of Echinacea. Noticeable improvement in the liver damage was observed upon the addition of silymarin to Echinacea. A marked decrease of intracellular protein and glycogen staining was evident after the administration of CCl₄. Slight improvement in protein and glycogen staining was noted after 36?mg/kg of Echinacea. Increased hepatic protein and glycogen staining intensity was observed after silymarin and Echinacea co-treatment compared with Echinacea-only treated groups. Silymarin only treatment resulted in more or less normal histopathological and histochemical findings. The present results suggest that administration of Echinacea extract reduces the hepatoprotective effect of silymarin. Such finding is likely to have important clinical significance in patients with hepatic disease on silymarin treatment.     

Amino Acid and Acylcarnitine Profiles in Premature Neonates: A Pilot Study

Objective

To investigate the longitudinal changes in amino acid (AA) and acylcarnitine (AC) profiles of preterm neonates over the first 2 wk of life, and to detect any significant deviation from full term values that requires change of cut-off values used for detection of metabolic disorders in preterm neonates.

Methods

This observational analytical longitudinal study was conducted on 131 premature neonates (gestational age ranged from 27 to 36 wk) and 143 healthy full-term neonates. Dried blood spots were taken on the 5th and 14th postnatal day from the premature neonates and on day 5 from full term neonates for neonatal screening. Samples were analyzed for AA and AC using tandem mass spectrometer.

Results

Most AA significantly decreased on day 14 compared to day 5 among preterm neonates (p?<?0.05). The combined values of total carnitine (TC), total acylcarnitine (tAC) and short-chain acylcarnitines on day 5 among preterm neonates were statistically significantly higher compared to the day 14 sample (p 0.0001), whereas no statistically significant difference was found regarding the values of medium-, long-chain acylcarnitines, tAC/FC, and FC/TC (p?>?0.05). The levels of AA of preterm neonates were statistically significantly higher than that of the controls (p?<?0.05). The values of TC, tAC, short-, medium- and long-chain acylcarnitines, were significantly higher than those of the controls (p?<?0.05). The reference ranges for preterm neonates were determined using the 1st and 99.9th percentiles.

Conclusions

AA and AC showed an age-related distribution of their concentrations. This underlines the importance of using appropriate reference values when working with a prematurely born population.     

Antihypertensive and cardioprotective effects of pumpkin seed oil

Pumpkin seed oil is a natural product commonly used in folk medicine for treatment of prostatic hypertrophy. In the present study, the effects of treatment with pumpkin seed oil on hypertension induced by the nitric oxide synthase inhibitor N(ω)-nitro-L-arginine methyl ester hydrochloride (L-NAME) (50?mg /kg/day) in rats were studied and compared with those of the calcium channel blocker amlodipine. Pumpkin seed oil (40 or 100?mg/kg), amlodipine (0.9?mg/kg), or vehicle (control) was given once daily orally for 6 weeks. Arterial blood pressure (BP), heart rate, electrocardiogram (ECG) changes, levels of serum nitric oxide (NO) (the concentrations of nitrite/nitrate), plasma malondialdehyde (MDA), blood glutathione, and erythrocytic superoxide dismutase activity were measured. Histopathological examination of heart and aorta was conducted as well. L-NAME administration resulted in a significant increase in BP starting from the second week. Pumpkin seed oil or amlodipine treatment significantly reduced the elevation in BP by L-NAME and normalized the L-NAME-induced ECG changes-namely, prolongation of the RR interval, increased P wave duration, and ST elevation. Both treatments significantly decreased the elevated levels of MDA and reversed the decreased levels of NO metabolites to near normal values compared with the L-NAME-treated group. Amlodipine also significantly increased blood glutathione content compared with normal (but not L-NAME-treated) rats. Pumpkin seed oil as well as amlodipine treatment protected against pathological alterations in heart and aorta induced by L-NAME. In conclusion, this study has shown that pumpkin seed oil exhibits an antihypertensive and cardioprotective effects through a mechanism that may involve generation of NO.     

Serum ferritin,transferrin and metabolic syndrome are risk factors for subclinical atherosclerosis in Egyptian women with systemic lupus erythematosus (SLE)

Aim of the work

This work aimed to measure serum ferritin and transferrin levels and to study the presence of metabolic syndrome (MetS) in Egyptian systemic lupus erythematosus (SLE) females and to correlate them with disease activity, damage, clinical status and subclinical atherosclerosis.