Insulin Sensitivity and Variability in Hepatitis C Virus Infection Using Direct Measurement

Background and Aims

Studies investigating insulin resistance (IR) in chronic hepatitis C virus (HCV) infection have used surrogate measures of IR that have limited reliability. We aimed to describe the distribution and risk factors associated with IR and its change over time in HCV using direct measurement.

Methods

One hundred two non-cirrhotic, non-diabetic, HCV-infected subjects underwent clinical, histologic, and metabolic evaluation, and 27 completed repeat evaluation at 6 months. Insulin-mediated glucose uptake was measured by steady-state plasma glucose (SSPG) concentration during the insulin suppression test.

Results

Three subjects with diabetes were excluded and 95 completed all testing. SSPG ranged from 39 to 328 mg/dL (mean 135 mg/dL) and was stable over time (mean SSPG change ?0.3 mg/dL). SSPG was associated with Latino ethnicity (Coef 67, 95 % CI 37–96), BMI (Coef 19 per 5 kg/m², 95 % CI 5–32), ferritin (Coef 1.4 per 10 ng/ml, 95 % CI 0.2–2.5), male gender (Coef ?48, 95 % CI ?80 to ?16), and HDL (Coef ?16, 95 % CI ?28 to ?5 mg/dL). Current tobacco use (Coef 55, 95 % CI 19–90), steatosis (Coef ?44, 95 % CI ?86 to ?3), and increases in BMI (Coef 30 per 5 kg/m², 95 % CI 6–53) and triglyceride (Coef 3.5 per 10 mg/dL, 95 % CI 0.3–6.7) predicted change in SSPG.

Conclusions

There was a wide spectrum of insulin resistance in our HCV population. Host factors, rather than viral factors, appeared to more greatly influence insulin action and its change in HCV.     

Carbon dioxide embolism during endoscopic vein harvesting

Endoscopic vein harvesting (EVH) is becoming common for the patients undergoing coronary artery bypass grafting. Using carbon dioxide insufflations during the vein harvest can produce rare but catastrophic CO(2) embolism. We report a case of massive right atrial CO(2) embolism due to femoral vein injury which occurred during the performance of a routine EVH procedure.     

Persistent torticollis,facial asymmetry,grooved tongue,and dolicho-odontoid process in connection with atlas malformation complex in three family subjects

Congenital clefts and other malformations of the atlas are incidental findings identified while investigating the cervical spine following trauma. A persistent bifid anterior and posterior arch of the atlas beyond the age of 3–4 years is observed in skeletal dysplasias, Goldenhar syndrome, Conradi syndrome, and Down’s syndrome. There is a high incidence of both anterior and posterior spina bifida of the atlas in patients with metabolic disorders, such as Morquio’s syndrome [Baraitser and Winter in London dysmorphology database, Oxford University Press, 2005; Torriani, Lourenco in Rev Hosp Clin Fac Med Sao Paulo 53: 73–76, 2002]. We report two siblings and their mother, with congenital, persistent torticollis, plagiocephaly, facial asymmetry, grooved tongues, and asymptomatic “dolicho-odontoid process”. All are of normal intelligence. No associated Neurological dysfunction, paresis, apnoea, or failures to thrive were encountered. Radiographs of the cervical spine were non-contributory, but 3D CT scanning of this area allowed further visualisation of the cervico–cranial malformation complex in this family and might possibly explain the sudden early juvenile mortality. Agenesis of the posterior arch of the atlas and bifidity/clefting of anterior arch of the atlas associated with asymptomatic “dolicho-odontoid process” were the hallmark in the proband and his female sibling. Some of the features were present in the mother. All the family subjects were investigated. To the best of our knowledge the constellation of malformation complex in this family has not been previously reported.

     

Hemodynamic effects and safety of nesiritide in neonates with heart failure

OBJECTIVE: Evaluate effects and safety of nesiritide (Natrecor, Scios Inc.) human B-type natriuretic peptide, in neonates with heart failure. METHODS: Seventeen neonates, not responding to conventional therapy, treated with nesiritide were retrospectively reviewed. RESULTS: Average age 16 + 8 days; weight 3.2 + 0.6 kg. Fifteen treated with concomitant inotropic therapy; all with diuretics. Twelve received loading dose; followed by continuous infusions of 0.005 mcg/kg/min (2); 0.01 mcg/kg/min (12); 0.02 mcg/kg/min (3). Length of therapy 5 + 4 days. No change in heart rate or blood pressure between baseline, 1 hour or 24 hours of nesiritide infusion. Decrease central venous pressure (CVP) 24 hours after infusion (p = 0.03). Ins-out ratio improved in 29%. No difference in pre and post therapy BUN and creatinine (Cr). 18% had hypotension requiring intervention. CONCLUSIONS: Nesiritide use in neonates may improve hemodynamics as demonstrated by reduction in CVP. All patients tolerated bolus dosing, however, transient hypotension occurred in 18% of neonates with continuous infusion.