POSSIBLE ROLE OF HYPERAMMONAEMIA AND/OR OF PORTOSYSTEMIC SHUNTS ON THE VARIABILITY OF THE TSH RESPONSE TO TRH IN CIRRHOTIC PATIENTS

1978 ◽  
Vol 89 (2) ◽  
pp. 284-295 ◽  
Author(s):  
J. L. Schlienger ◽  
M. Hasselmann ◽  
M. Imler
Keyword(s):  
Liver Disease ◽  
Disease Group ◽  
Portosystemic Shunts ◽  
Advanced Cirrhosis ◽  
Free Thyroxine Index ◽  
Group A ◽  
Cirrhotic Patients ◽  
The Mean ◽  
Group B

ABSTRACT Serum concentrations of thyroid hormones (T3, T4) and the TSH response to TRH administered iv were measured by radioimmunoassay in 21 patients with advanced cirrhosis and compared to 20 control patients without liver disease (group A). While the mean T4 values (8.6±0.3 μg/100 ml) were similar for the two groups, the mean T3 values were significantly lower in patients with liver disease (123 ± 12 vs. 156 ± 10 ng/100 ml). The mean baseline TSH levels and the magnitude of the peak were normal but very scattered in these patients. The TSH response to TRH appeared independant of nutritional status, T4 and T3, anaemia, hypoalbuminaemia, transaminasaemia and bilirubinaemia. The TSH release after TRH injection seemed however to be markedly elevated in cirrhotic patients with hyperammonaemia. Therefore, patients with liver disease were separated into two groups according to the absence (group B; n = 11) or the presence (group C; n = 10) of hyperammonaemia. Mean T4 values and the free thyroxine index were lower in group C (7.2 ± 0.6 vs. 9 ± 0.6 μg/100 ml and 1.87 ± 0.16 vs. 2.49 ± 0.15) but mean T3 and basal TSH values did not differ in group B and C. The TSH response was slightly dispersed in B and lower than that observed in A or in C (P < 0.01). A hyperresponsiveness in 4 patients and a hyperresponsiveness in 2 other patients was noted in group C without any correlation with the basal TSH value or T3 or T4 Since hyperammonaemia has been considered as a biological parameter of hepatic encephalopathy, it is suggested that the THS release which is neuraminergic controlled may be altered by this situation resulting in a cerebral aminergic mediators depletion.

Tissue Ki67 proliferative index expression and pathological changes in hemodialysis arteriovenous fistulae: Preliminary single-center results

2021 ◽  
pp. 112972982110154
Author(s):  
Raffaella Mauro ◽  
Cristina Rocchi ◽  
Francesco Vasuri ◽  
Alessia Pini ◽  
Anna Laura Croci Chiocchini ◽  
...  
Keyword(s):  
Morphological Changes ◽  
Hot Spot ◽  
Wall Thickening ◽  
Proliferating Cells ◽  
Ki 67 ◽  
Group A ◽  
The Mean ◽  
Set Up ◽  
Group B

Background: Arteriovenous fistula (AVF) for hemodialysis integrates outward remodeling with vessel wall thickening in response to drastic hemodynamic changes. Aim of this study is to determine the role of Ki67, a well-established proliferative marker, related to AVF, and its relationship with time-dependent histological morphologic changes. Materials and methods: All patients were enrolled in 1 year and stratified in two groups: (A) pre-dialysis patients submitted to first AVF and (B) patients submitted to revision of AVF. Morphological changes: neo-angiogenesis (NAG), myointimal thickening (MIT), inflammatory infiltrate (IT), and aneurysmatic fistula degeneration (AD). The time of AVF creation was recorded. A biopsy of native vein in Group A and of arterialized vein in Group B was submitted to histological and immunohistochemical (IHC) analysis. IHC for Ki67 was automatically performed in all specimens. Ki67 immunoreactivity was assessed as the mean number of positive cells on several high-power fields, counted in the hot spots. Results: A total of 138 patients were enrolled, 69 (50.0%) Group A and 69 (50.0%) Group B. No NAG or MIT were found in Group A. Seven (10.1%) Group A veins showed a mild MIT. Analyzing the Group B, a moderate-to-severe MIT was present in 35 (50.7%), IT in 19 (27.5%), NAG in 37 (53.6%); AD was present in 10 (14.5%). All AVF of Group B with the exception of one (1.4%) showed a positivity for Ki67, with a mean of 12.31 ± 13.79 positive cells/hot spot (range 0–65). Ki67-immunoreactive cells had a subendothelial localization in 23 (33.3%) cases, a myointimal localization in SMC in 35 (50.7%) cases. The number of positive cells was significantly correlated with subendothelial localization of Ki67 ( p = 0.001) and with NA ( p = 0.001). Conclusions: Native veins do not contain cycling cells. In contrast, vascular cell proliferation starts immediately after AVF creation and persists independently of the time the fistula is set up. The amount of proliferating cells is significantly associated with MIT and subendothelial localization of Ki67-immunoreactive cells, thus suggesting a role of Ki-67 index in predicting AVF failure.

The role of tolvaptan in prevention of hyponatremia in patients undergoing transurethral resection of prostate surgery- A randomized double blind study

2021 ◽  
Vol 8 (2) ◽  
pp. 321-325
Author(s):  
Dinesh Kumar Singh ◽  
B B Baj ◽  
Vipin Goyal
Keyword(s):  
Transurethral Resection ◽  
Blind Study ◽  
Transurethral Resection Of Prostate ◽  
Double Blind Study ◽  
Double Blind ◽  
Significant Difference ◽  
Group A ◽  
The Mean ◽  
Group B

The aim of our study to determine the role of tolvaptan in prevention of hyponatremia in transurethral resection of prostate surgery. This is randomized double-blind study conducted in 60 ASA grade status 1 and 2 patients age group between 45-80 yrs undergoing TURP under spinal anaesthesia in urology operation theatre in Mahatma Gandhi hospital Jaipur after receiving permission from hospital ethical committee. A detailed history, complete physical examination and routine investigation were done for all patients followed by informed written consent was obtained. Patients are randomly divided into 2 groups. In group A -30 patients who received orally tab tolvaptan 15 mg and group B-30 patients who received orally tab multivitamin 2 hrs before surgery after doing electrolytes of the patients in the morning. In both groups age (in yrs), wt (in kg), ASA grade, volume of irrigating fluid (in litres), volume of prostate resected (in gm) and duration of surgery (in minutes) all demographic and surgical details data were compared. Electrolytes were compared in both groups pre and post-operatively and statistical analysis was done.There was significant difference in post-operative sodium level between the two groups (A and B). The mean level of sodium significantly reduced post-operatively in group –B (control grp). The mean level of sodium significantly increased post-operatively in group –A (tolvaptan grp). We conclude single dose of tolvaptan -15 mg found to effective in prevention of hyponatremia in patients undergoing TURP.

scholarly journals Role of Hypotensive Anaesthesia in Functional Endoscopic Sinus Surgery in Private Practice

2020 ◽  
Vol 24 (1) ◽  
pp. 8-13
Author(s):  
Md Nurullah ◽  
Md Arif Hossain Bhuyan ◽  
Syed Ariful Islam ◽  
Md Shah Alam
Keyword(s):  
Heart Rate ◽  
Endoscopic Sinus Surgery ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Controlled Hypotension ◽  
Operative Field ◽  
Group A ◽  
The Mean ◽  
Group B

Background: Functional endoscopic sinus surgery (FESS), effective control of bleeding is essential to maintain a clear operative field and to minimize complications. Intraoperative bleeding is one of the major problems in endoscopic surgery of sinuses. Controlled hypotension is a technique used to limit intraoperative blood loss to provide the best possible field for surgery. Objective: The objective of study was role of Hypotensive Anaesthesia in Functional Endoscopic Sinus Surgery and designed to compare intraoperative hemorrhage and the visibility of the operative field during normotension and hypotension anesthesia. Methods: Prospective randomized study includes a total of 60 ASA I-II patients who underwent elective FESS surgery. Patients randomly assigned in two groups the hypotension group (Group A) and the normotension group (Group B). Intraoperative mean arterial pressure (MAP), heart rate (HR) were recorded. Results : This study shows the mean ages of the patients of group A group B were 33.36±7.61 and 32.46±7.73 years respectively. No statistically significant difference was observed among groups at 0.05 level in term of age. The mean heart rate pre-anaesthesia and preoperative among the patients of different groups in different follows up period. Significance differences were observed among groups in term of heart rate at 5 minute, 15 minute, 30 minute, 45 minute and 60 minute. The mean arterial mean blood pressure before pre-anaesthesia and preoperative estimation among the patients of different groups in different follows up period. Significance differences were observed among groups at 5 minute, 15 minute, 30 minute, 45 minute and 60 minute. Conclusion: This study demonstrated that Controlled hypotension can be achieved equally and effectively by nitroglycerin and labetalol reduced significantly intraoperative hemorrhage and produce hypotensive anesthesia. Both are equally effective in providing ideal surgical field during functional endoscopic sinus surgery (FESS). Bangladesh J Otorhinolaryngol; April 2018; 24(1): 8-13

scholarly journals A Comparative Evaluation on the effect of Zinc-Probiotic combination versus Zinc alone therapy in children (3month-5year) with acute watery diarrhea attending the outpatient clinic of Sub-District hospital, Uttarakhand

2021 ◽  
Vol 9 (4) ◽  
pp. 263-268
Author(s):  
Dr. Mamta Nikhurpa ◽  
◽  
Dr. Renu Agnihotri ◽  
Keyword(s):  
Watery Diarrhea ◽  
Male Predominance ◽  
Watery Stool ◽  
Acute Watery Diarrhea ◽  
Group A ◽  
Study Population ◽  
The Mean ◽  
Group B ◽  
Time Required

Background: Diarrhea is the major cause of morbidity and mortality among children worldwide.Various studies were done on the role of zinc therapy and probiotic therapy in reducing the durationand severity of acute watery diarrhea. This study aimed to compare the effect of Zinc –probioticcombination versus Zinc only therapy in acute watery diarrhea in pediatric patients. Material andMethods: This was an open, randomized control trial in the pediatric outpatient department of Sub-District Female Hospital, Haldwani (Uttarakhand), from June 2020 till August 2020 for three months.Total 104 children aged six months to 5 years with acute diarrhea who met the inclusion criteriawere enrolled and divided into 52 patients each. 1stGroup A (n=52) received Zinc-Probioticscombination therapy, and 2ndGroup B (n=52) received Zinc only. Measurement of disease severitywas based on the frequency of diarrhea (times/day) and duration of diarrhea (hours) after initialdrug consumption. The resolution was assessed in mean remission time (time required to form solidstool from watery stool).Result: Among the study population in group A, 62% were male, 38%were female, and in group B, 65% were male & 35% were female. Male predominance was observedin both groups. The mean frequency of diarrhea before treatment in Group A was 7.46 ± 4.1times/day as compared to 6.69 ± 3.6 times/day in Group B. Mean duration of diarrhea in Group Awas 53.5 ± 30.5 hours as compared to 57.6 ± 34.3 hours in Group B. Conclusion: Combinationtherapy was more effective than Zinc only therapy in early remission and resolution of acute waterydiarrhea in children.

scholarly journals Association of Adverse Effects of Red Meat Consumption with Liver Cirrhosis

2021 ◽  
Vol 15 (5) ◽  
pp. 1768-1770
Author(s):  
Gulshad Wagan ◽  
Abdullah Khilji ◽  
Kaleem Sheikh ◽  
Syed Sohail Abbas Naqvi ◽  
Imtiaz Wagan ◽  
...  
Keyword(s):  
Liver Disease ◽  
Chronic Liver Disease ◽  
Meat Consumption ◽  
Red Meat ◽  
Adverse Outcomes ◽  
Chronic Liver ◽  
P Value ◽  
Group A ◽  
Cirrhotic Patients ◽  
Group B

Objective: To determine the association of adverse outcomes in term of mortality in patients with cirrhosis and red meat consumption. Study Design: Cross-sectional Place and Duration: Medicine Department of Liaquat University Medical Hospital Jamshoro and Civil Hospital Khairpur Mir's for six months duration from December 2019 to November 2020. Methodology: Total 120 patients of both genders with chronic liver disease were enrolled in this study. Patients were categorized in to two groups. Group A (red meat consumption >60 gm/day) and group B (red meat consumption <60gm/day). Outcomes in term of mortality between both groups were examined. All the data was analyzed by SPSS 27.0. Results: There were 36 (60%) males and 24 (40%) were females with mean age 48.14±7.58 years in group A while in group B 39 (65%) and 21 (35%) patients were males and females with mean age 49.08±8.33 years. Cirrhotic patients with red meat consumption >60 gm/day had high mortality rate as compared to patients with red meat consumption <60 gm/day (10% Vs 3.33%) with p-value 0.0001. Conclusion: A significant association of adverse outcomes was found in cirrhotic patients and red meat consumption. Keywords: Chronic Liver Disease, Red Meat Consumption, Mortality

scholarly journals Role of terminal and anastomotic circulation in the patency of arteries jailed by flow-diverting stents: from hemodynamic changes to ostia surface modifications

2017 ◽  
Vol 126 (5) ◽  
pp. 1702-1713 ◽  
Author(s):  
Christina Iosif ◽  
Philipp Berg ◽  
Sebastien Ponsonnard ◽  
Pierre Carles ◽  
Suzana Saleme ◽  
...  
Keyword(s):  
Flow Rate ◽  
Stent Placement ◽  
Mean Flow ◽  
Hemodynamic Changes ◽  
Flow Rates ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
The Right

OBJECTIVEThe outcome for jailing arterial branches that emerge near intracranial aneurysms during flow-diverting stent (FDS) deployment remains controversial. In this animal study, the authors aimed to elucidate the role of collateral supply with regard to the hemodynamic changes and neointimal modifications that occur from jailing arteries with FDSs. To serve this purpose, the authors sought to quantify 1) the hemodynamic changes that occur at the jailed arterial branches immediately after stent placement and 2) the ostia surface values at 3 months after stenting; both parameters were investigated in the presence or absence of collateral arterial flow.METHODSAfter an a priori power analysis, 2 groups (Group A and Group B) were created according to an animal flow model for terminal and anastomotic arterial circulation; each group contained 7 Large White swine. Group A animals possessed an anastomotic-type arterial configuration to supply the territory of the right ascending pharyngeal artery (APhA), while Group B animals possessed a terminal-type arterial configuration to supply the right APhA territory. Subsequently, all animals underwent FDS placement, thereby jailing the right APhAs. Mean flow rates and velocities inside the jailed branches were quantified using time-resolved 3D phase-contrast MR angiography before and after stenting. Three months after stent placement, the jailed ostia surface values were quantified on scanning electron micrographs. The data were analyzed using descriptive statistics and group comparisons with parametric and nonparametric tests.RESULTSThe endovascular procedures were feasible, and there were no findings of in situ thrombus formation on postprocedural optical coherence tomography or ischemia on postprocedural diffusion-weighted imaging. In Group A, the mean flow rate values at the jailed right APhAs were reduced immediately following stent placement as compared with values obtained before stent placement (p = 0.02, power: 0.8). In contrast, the mean poststenting flow rates for Group B remained similar to those obtained before stent placement. Three months after stent placement, the mean ostia surface values were significantly higher for Group B (527,911 ± 306,229 μm2) than for Group A (89,329 ± 59,762 μm2; p < 0.01, power: 1.00), even though the initial dimensions of the jailed ostia were similar between groups. A statistically significant correlation was found between groups (A or B), mean flow rates after stent placement, and ostia surface values at 3 months.CONCLUSIONSWhen an important collateral supply was present, the jailing of side arteries with flow diverters resulted in an immediate and significant reduction in the flow rate inside these arteries as compared with the prestenting values. In contrast, when competitive flow was absent, jailing did not result in significant flow rate reductions inside the jailed arteries. Ostium surface values at 3 months after stent placement were significantly higher in the terminal group of jailed arteries (Group B) than in the anastomotic group (Group A) and strongly correlated with poststenting reductions in the velocity value.

scholarly journals HUBUNGAN OKSIDA NITRAT DAN NILAI HISTOPATOLOGIS PADA ENDOTOKSEMIA

2016 ◽  
Vol 20 (3) ◽  
pp. 201
Author(s):  
Sotianingsih Sotianingsih ◽  
Suharyo Suharyo ◽  
Lisyani S ◽  
Guntur HA
Keyword(s):  
Nitric Oxide ◽  
Treatment Group ◽  
Control Group ◽  
Significant Difference ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
Termination Time ◽  
Control Group Group

Lipopolysaccharide (LPS) is an endotoxin from the outer membrane of Gram-negative bacteria, which has an important role in the occurrence of sepsis. Exposure to LPS will stimulate increase of nitric oxide (NO). Nitric oxide is a bioregulator of apoptosis and has some sepsis prognostic role of apoptosis regulators within the gastrointestinal cells. The objective of the study is to know if endotoxemia induces an increase in NO levels and histopathology scores as well as the existing relationship between them. This study is an observational intervention. The subjects were 48 male mice Balb/C, divided into 2 groups. The samples consisted of 24 tail as control group (group A) and 24 as treatment group (group B). The A group as well as the B group is divided into 4 subgroups according to the time of termination. The levels of NO were examined by Griess method. Histopathology score was examined by HE and read as a score of 0–5. There was a statistically significant difference between the mean NO in the treatment group with the control group at the termination of the group of 12h (p=0.009), 24h (p=0.015), 36h (p=0.014), 48h (p=0.002) and the whole group (p=0.0001), as well as between the mean histopathology score at the termination time of 12 h (p=0.0001), 24h (p=0.0001), 36h (p=0.0001), 48h (p=0465) and the whole group (p=0.0001). Increase in NO and histopathology scores in all groups of mice (r=0.527) showed a statistically significant correlation. NO levels and histopathology scores are increased during endotoxemia and thus have a significant correlation.

scholarly journals Thickening of Gallbladder Wall in Chronic Liver Disease - A Marker for Esophageal Varices

2013 ◽  
Vol 6 (1) ◽  
pp. 18-20
Author(s):  
Shamsi Ara Begum ◽  
Arif Akbar Saibal ◽  
Kanta Das ◽  
Sharmistha Dey ◽  
Akhtar Uddin Ahmed ◽  
...  
Keyword(s):  
Liver Disease ◽  
Chronic Liver Disease ◽  
Esophageal Varices ◽  
Gallbladder Wall ◽  
Chronic Liver ◽  
Wall Thickening ◽  
Oesophageal Varices ◽  
Group A ◽  
The Mean ◽  
Group B

This study was done to find out the relationship between gallbladder wall thickening and esophageal varices in chronic liver disease (CLD) patients. A total of 61 CLD patients were included and divided into two groups. Group A included 13 CLD patients with no oesophageal varices and Group B composed of 48 CLD patients with esophageal varices. Mean gallbladder wall thickness (GBWT) of Group B was 5.6±0.2mm compared to 2.7±0.1mm of Group A. The mean differences of GBWT were statistically significant between group A and group B (P<0.05). The mean GBWT was significantly (p<0.05) higher in CLD patients with grade III and IV varices (6.1±.8 mm) compared to grade I and II (3.9±0.7 mm). The result suggests that GBWT may be considered as an important marker for the presence of esophageal varices in CLD patients. DOI: http://dx.doi.org/10.3329/imcj.v6i1.14713 Ibrahim Med. Coll. J. 2012; 6(1): 18-20

scholarly journals Role of Zinc in Patients Presenting with Recurrent Hepatic Encephalopathy in Medical Unit of Tertiarycare Hospital Lahore

Esculapio ◽  
2020 ◽  
Vol 16 (03, july 2020-Septmber 2020) ◽  
Author(s):  
Asma Kamal ◽  
Asifa Kamal ◽  
Naeem Afzal ◽  
Shazia Siddique ◽  
Khadija Tahir
Keyword(s):  
Hepatic Encephalopathy ◽  
Zinc Supplementation ◽  
Mean Value ◽  
Significant Difference ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
Improved Outcome

Abstract Objective: To observe the effects of zinc replacement on hepatic encephaopahty. To reducce hospital admission and heath burden by reducing episodes of recurrent hepatic encephalopathy. Methods: This study was carried out on 160 patients presenting with hepatic encephalopathy in medical ward of services hospital Lahore. The aim of the study was to assess the role of zinc in the improvement of encephalopathy. Results: The mean age of patients in group A was 55.78 and that in group B was 56.88years.There was significant difference in mean value of hepatic encephalopathy grade in both groups A and B after 3 months of follow up (p.value 0.027) indicating zinc is beneficial in treatment of hepatic encephalopathy. Conclusion: Our study showed that zinc replacement improved outcome in patients with Hepatic encephalopathy. Key words: Hepatic encephalopathy, zinc supplementation, chronic liver disease.

Mean platelet volume indicator for systemic inflammation in cirrhotic patients with spontaneous bacterial peritonitis

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Khaled Mohamed Abd El-Wahab ◽  
Moataz Mohamed Sayed ◽  
Mohamed Osama Ali ◽  
Abd El-Azem Mostafa Abd El-Azem
Keyword(s):  
Mean Platelet Volume ◽  
Spontaneous Bacterial Peritonitis ◽  
Platelet Volume ◽  
Bacterial Peritonitis ◽  
Function Test ◽  
Group A ◽  
Cirrhotic Patients ◽  
The Mean ◽  
Group B ◽  
Ascetic Fluid

Abstract Introduction spontaneous bacterial peritonitis (SBP) is the most common infection in patients with cirrhosis [1] .Spontaneous bacterial peritonitis is found in patients where besides the increase of polymorphonuclear counting, they present a positive result of culture [2] . The BMN count as not always quickly available in clinical practice and the culture result usually takes 72 hours or more [3] .The use of additional markers that are rapidly and easily applicable, may add significant benefit for predicting the development of spontaneous bacterial peritonitis and achieving diagnostic accuracy [4] .Platelet size is a determinant factor of platelet proinflammatory functions. Several studies have found relationship between the mean platelet volume (MPV) and pro-inflammatory conditions, particularly acute infections [5] . Aim to identify a mean platelet volume (MPV) cutoff value which should be able to predict the presence of sponataneous bacterial peritonitis. Settings and designs a cross sectional observational study, carried out on 40 patients with AFI and 40 patients without AFI. Methods Patients were classified into two groups, group A (SBP) which included 40 patients with ascetic fluid PMN count ≤ 250 cells/mm3 and group B (non/SBP) which included another 40 patients with ascetic fluid PMN count &lt; 250 cells/mm3. All studied patients were subjected to history taking, Clinical examination and routine laboratory investigations including: CBC including platelet number and MPV, liver function test including (ALT, AST, albumin, and direct & total bilirubin), kidney function test including (BUN &creatinine), PT, PTT, INR, ESR and CRP .Abdominal-pelvic ultrasonography was done for all patients. Aspirated ascetic fluid samples were immediately examined for bacteriological cultures. Statistical analysis used Statistical presentation and analysis of the present study was conducted, using the mean, standard deviation, independent samples t-test, Chi-square, Mann-Whitney U test and Analysis of variance [ANOVA] tests by SPSS version 22 software .Tukey test was used .Receiver operating characteristic (ROC) curve analysis was used to identify optimal cut-off values of MPV and with maximum sensitivity and specificity for differentiation of cirrhotic patients with SBP from those without SBP. Spearman’s correlation analysis was done. Results MPV was significantly higher in SBP-patients (Group A) than that of non-SBP patients (Group B) (11.6820±1.19303 fL versus 9.0325±1.12441 fL) (P-value = 0.001) .MPV has positive correlation with Ascitic sample TLC and Ascitic sample PMNC in Group A. ROC curve shows that MPV cut off value is10.25with 85% sensitivity and 75% specificity . Conclusion MPV may serve as a non-invasive, cheap and rapid test for detection and diagnosis of spontaneous bacterial peritonitis (SBP) with a sensitivity and specificity of 85% and 75% respectively.

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