Liver cirrhosis with high IgG4 in a patient with, diabetes mellitus, ulcerative colitis with papillary thyroid cancer, is it all related ? which one to blame& is it time to raise awareness about IGG4 and hepatobiliary diseases
Back ground: There is possible etiological relation between high IgG4 in a patient with liver cirrhosis, ulcerative colitis, diabetes mellitus , prostatitis ,venous thrombosis and thyroid cancers and the use of immunosuppressive & biologic agents. Method: a study of patient with multiple organ involvement with persistently elevated IgG4. A 56 years old male with persistently elevated IgG4 over 2.5 times normal level, diabetic on insulin, ulcerative colitis on azathioprin & adalimumab developed deep skin pigmentation and liver enzymes elevation with portal hypertension and liver cirrhosis, azathioprine & adalimumab were stopped and golimumab started, after 3 infusions of golimumab papillary thyroid cancer developed .Total thyroidectomy followed by radio iodine after which severe sialo adenitis developed which responded to steroids. His ulcerative colitis was treated with vedolizumab with good response. liver cirrhosis progressed with bleeding varices and portal vein thrombosis with factor Leiden V mutation. Results and conclusions: High IgG4 can be related to many organs including pancreas,liver,thyroid ,small and large bowel,parotid glands ,in this patients all these were affected resulting in colitis,diabetes,liver cirrhosis and thyroid cancer and sialo adenitis. Awareness is needed on the associations with high IgG4. Conclusion: A patient with elevated IgG4 , liver cirrhosis , diabetes mellitus, ulcerative colitis developed skin pigmentation, and papillary thyroid cancer associated with persistently elevated IgG4.
This article covers the epidemiology, pathophysiology/complications and management of diabetic gastroparesis (DGP), and more broadly diabetic gastroenteropathy, which encompasses all the gastrointestinal manifestations of diabetes mellitus (DM). Hyperglycemia, autonomic neuropathy, and enteric neuromuscular inflammation and injury are implicated in the pathogenesis of delayed gastric emptying (GE). Initial options include dietary modifications, supplemental oral nutrition, and antiemetic and prokinetic medications. Patients with more severe symptoms may require a venting gastrostomy or jejunostomy and/or gastric electrical stimulation (GES). To date, few population-based studies have estimated the true prevalence and incidence of gastroparesis. Nonetheless, its prevalence appears to be rising, as does its incidence among minority populations, documented via hospitalizations, which can impose significant economic burdens on patients.
Electronic Procedural Reporting for Colonoscopy; Challenges (Discrepancies) in Data Entry and Report Generation
Aims: Computerized reporting systems that generate standardized endoscopy reports are available and facilitate easy retrieval of data for quality assurance review. We aim to compare the accuracy of extracted database fields in our reporting system (endoPRO) for key measures of quality to the final edited endoscopy report for colonoscopy procedures. Methods: In a retrospective analysis, we compared data retrieved from endoPRO to the final colonoscopy reports at Hamilton Health Sciences (HHS). The data included demographics, indications for procedures, bowel prep quality, findings, extent of exam, and recommendations. Discrepancies, changes or missing information pertaining to key quality indicators for colonoscopies were recorded. Results: In total, 1843 colonoscopy procedures were done at HHS from January to March 2010, and reports for 592 colonoscopies, randomly selected, were analyzed for this study. Discrepancies were seen in: Indication – 34 cases (5.7%), Assistants present during colonoscopy – 94 cases (15.9%), Quality of bowel preparation – 35 cases (5.9%), Findings & impressions – 38 cases (6.4%) including polyps, inflammation, diverticulosis and haemorrhoids. Conclusions: Our study demonstrates the variability between data found in patients’ final colonoscopy reports and data retrieved from the endoscopy databases. Structured endoscopy reporting and the use of databases facilitate quality assurance but editing of procedure reports after structured data entry compromises accuracy of the data in key quality measures. Inaccurate or incomplete data recording will compromise the enhancements in quality assurance that would accrue otherwise from regular audit processes.
Breakfast, the first meal of the day, is considered the most important meal throughout the day. As nutritionist Adelle Davis famously put it back in the 1960s: “Eat breakfast like a king, lunch like a prince and dinner like a pauper”. Breakfast is most commonly skipped meal more than lunch and dinner specifically in the young adult in the university study period and those who wake up late. Lack of time is the main reason behind skipping meals, in general, lack of appetite, inability to cook, fasting/religion, and not being hungry. Many people are used to be in a hurry for job, business, children’s’ school in the morning where a filled stomach may prevent them to walk a long way. It is obvious that the irregular omission of breakfast may be effective in energy intake reduction over the next 24 hours and in this day, exercise performance may be compromised. There is no evidence that breakfast skipping reduces overeating or prevent weight gain. Some people argue that breakfast and good health is a marketing strategy by breakfast companies.
Phytochemical Antimicrobial Screening of Costus Afer Extract and Its Alleviation of Carbon Tetrachloride Induced Toxicity
Plants of medicinal values contain bioactive compounds capable of preventing and combating several oxidative related diseases. Many diseases have been wrongly attended to using several medicinal plants of choice by mere instinct or sunrise. The phytochemical screening, (antimicrobial activity of Costus afer extract and its alleviation of carbon tetrachloride induced toxicity were evaluated. The phytochemical screening of both qualitative and quantitative analyses showed the presence of Tannins, Steroids, Phenols, Phytate, Hydrogen cyanide (HCN). Saponin, Alkaloids and Flavonoids in the aqueous, methanol and n-hexane stem extract. The antimicrobial activity of Costus afer extract using two different solvents showed its bactericical effect and no antibiotic effect on fungi microorganisms at different concentration. The study based on the toxicity of the substance, carbon tetrachloride showed the serum elevation of alanine aminotransferase (ALT, EC 126.96.36.199.), aspirate aminotransferase (AST, EC 188.8.131.52) and alkaline phosphase (ALT, EC 184.108.40.206) in the liver of the rabbits in response to the oral administration of the chemical. The rabbits fed with the Costus afer extract of methanol and N-hexane showed a moderate effect while the rabbits fed with the chemical carbon tetrachloride had a very high elevation on the enzymes. The rabbits, however fed with both the Costus afer and the chemical compound, carbon tetrachloride showed a considerable alleviation on the level of toxicity of the chemical. The rabbits fed with the Costus afer extract and the chemical carbon tetrachloride mixture statistically showed significant (p
Introduction: Due to the aging process, there are disabling chronic diseases that have gained greater evidence in the public health scenario. Among them is diabetes mellitus (DM), which is one of the most common chronic diseases among the elderly. Life style is an important determinant of glycemic control in type 2 diabetic patients. Objectives: To describe the lifestyle of type 2 diabetic patients treated at the Family Health Basic Unit III, in the city of Santa Cecília-PB. Methodology: Descriptive study, population composed of 55 diabetics, adults, type 2, data collected from a pre-structured interview. Results and Discussion: 56% female, 44% male, 29% have good eating habits, 8% practice regular physical exercises, 75% are overweight, 20% are medicated. The World Health Organization considers that the diet of the diabetic is one of the factors responsible for keeping the glycemic levels within desirable limits. The survey found that only 29% of those involved have a proper diet with a very low index. Many studies suggest that sedentarism favored by modern life is a risk factor as important as inadequate diet in the etiology of obesity and has a direct and positive relationship with the increased incidence of DM 2 in adults. The practice of physical exercise for people living with diabetes is very low. Only 8% reported regular exercise. Conclusion: It is important to emphasize that glycemic control depends, in addition to drug therapy, on changes in lifestyle. Since 90% of respondents said they had good adherence to drug treatment. It is necessary to implement strategies that seek to raise awareness about the importance of lifestyle change.
Introduction: Diabetic neuropathy is one of the complications that integrates the pathogenic diabetic foot triad. This neuropathy leads to a foot sensory loss, making the patient vulnerable to minor injuries that could precipitate lesions, subsequent infection and foot amputation. Therefore, the diagnosis needs to come from a complete and detailed physical examination. Objective: The present study aims to investigate the incidence of diabetic foot in diabetic patients who are users of the Basic Health Unit (BHS) in the city of Olinda, Pernambuco. Methodology: The sample of this descriptive exploratory of quantitative methods study was composed of 50 diabetic users of the Basic Health Unit. After signing a Free and Informed Consent Form, a questionnaire was applied regarding the perception of the diabetic on signs and symptoms which are observed in the diabetic foot, proceeding with a thorough evaluation of the feet using 10g of monofilament and performing the Pin Prick Test. Results and Discussion: In total, 70% of patients reported poor glycemic control, 63% reported neuropathic symptoms such as numbness and tingling in the feet and 57% of the evaluated patients have thickened nails and dried or scaly feet. Regarding the vascular evaluation 47% of the evaluated presented with a decreased pedal pulse and 7% presented with this same pulse absent, while 40% had decreased posterior tibial pulse and 7% did not present any pulse at palpation. Regarding the sensitivity assessment, 30% of diabetics presented abnormal results in one of the feet and 7% had no painful and tactile reflex through the sting sensation test. Conclusion: A preventive evaluation of the feet on diabetic patients resulted in important data that informs about the high prevalence of neuropathic findings, contributing to a greater knowledge for the UBS professional team about the presence of neuropathic foot in their diabetic users.
Introduction: Obesity is a chronic disease, besides a risk factor for cardiovascular diseases, nowadays, it is characterized as a worldwide epidemic. The food imbalance and physical inactivity are factors that contribute to the emergence of obesity as well as diabetes. Objective: To evaluate the injury on glucose tolerance and insulin sensitivity in obese rats induced by high fat diet. Methodology: Male Rats Wistar (8 weeks old) were submitted to the standard diet (chow group, 11.8% kcal-Lipids; n = 5) and dietary intervention with high fat diet during 8 weeks (HFD group, 58.4% kcal-Lipids; n= 5). It was evaluated the body weight weekly, and fasting and fed blood glucose. At the end of the experimental period, was measured the glucose tolerance, insulin sensitivity and gluconeogenesis. After the animal sacrifice, it was analyzed relative weight of white adipose tissue, as well as the adipocytes diameter (epididymal white adipose tissue) and circulating levels of leptin. Results and Discussion: The group HFD presented higher body weight (from the 2nd week of diet), an increase accumulation of epididymal and perirenal white adipose tissue. In addition, in these animals, it was observed a significant increase in the adipocytes diameter and the levels of leptin in plasma when compared to animals chow, indicating obesity with increased release of cytokines. In HFD group, the fasting blood glucose levels were significantly higher in the 6th week of high fat diet consumption compared to the chow group. Adding up to the frame of obesity, at the end of the 8th week of high fat diet consumption, the obese group had higher fasting plasma glucose in fed state, glucose intolerance, insulin resistance, as well as increased gluconeogenesis as compared with the chow group. Conclusion: Obesity with adipocyte hypertrophy, induced by high fat diet, induces glycemic damages, as the elevation of blood…
Introduction: The high intake of carbohydrates and lipids is one of factors that contribute to the onset of Metabolic Syndrome (MetS), a complex clinical situation which brings together, besides obesity, several cardiovascular and metabolic risk factors, including non-alcoholic fatty liver disease (NAFLD). Objective: To develop a hyperlipidemic dietetic animal model to obesity associated with NAFLD. Methodology: Male Rats Wistar (8 weeks old) were submitted to the standard diet (chow group, 11,8% kcal- lipids) and hypercaloric and hyperlipidemic during 8 weeks (HFD group, 58,4% kcal-lipids). After the dietary intervention, body weight, plasma and hepatic lipid profile (triglycerides, total cholesterol, VLDL and fatty acids) and adiposity index were evaluated. Moreover, histological assessment of hepatic lipid deposition and fibrosis, as well as the hepatic damage marker (alanine aminotransferase-ALT) were evaluated. Results and Discussion: Comparing to the chow group, HFD animals presented higher body weight, both in fasting and in the fed state, increased abdominal circumference, adiposity index, as well as plasma levels of total cholesterol and non-esterified fatty acids, characterizing the dietary phenotype of obesity. In addition, the HFD group had a significant decrease in brown adipose tissue, together with the lowest weight loss induced by 16h overnight fasting, suggesting a decrease in energy expenditure. In the liver, the HFD group presented a significant increase in the levels of triglycerides, cholesterol, VLDL and non-esterified fatty acids, and, qualitatively, increased lipid deposition and fibrosis. Together, these results associated with increased plasma ALT activity indicate NAFLD with hepatocyte damage. Conclusion: A high fat diet intake induces comorbidities that characterize MetS, such as obesity associated with decreased energy expenditure, as well as NAFLD.
Analysis of Hepatotoxic and Lipidic Profiles in Students of an Institution of Private Higher Education, Since the Use of Literacy Drugs
A Introduction: In most countries, drug use is regulated by official bodies that determine which substances can be consumed. However, in many countries, alcoholic beverages and cigarettes, for example, are licit drugs although their consumption is usually of no medicinal purpose. According to the World Health Organization, alcohol dependence affects about 10 to 12% of the world’s population and alcohol is recognized as a major cause of mortality and disability. One in 20 deaths is attributed to the consumption of alcohol, a licit drug that kills more than AIDS, tuberculosis and violence together, warns the WHO. Objective: The objective of this project is to analyze hepatotoxic and lipid profiles in students of a private higher education institution, due to the use of licit drugs. Metodology: The study was a cross-sectional, experimental, quantitative and qualitative study, in which the hepatic and lipid biochemical aspects of licit drug users and the sample profile were evaluated based on a questionnaire, the total sample of the study added 300 individuals representing the population total. Results and Discussion: Based on the results it was verified that 205 (68.3%) of the students answered that they consumed at least one or more drugs in the month, being only alcohol, and only 95 (31.7%) did not use any drugs damn it. Among women, 218 (72.7%), drink and only, 28 (11.3%) do not drink. Regarding men, 27 (50%) drink and 27 (50%) do not drink. The level of consumption was observed that, 139 (46.3) consume five or more doses of alcoholic beverage on one occasion, and 83 (27.8%) drink more than once in the month. Conclusion: According to the data, it is inferred that there was a strong incidence in the consumption of alcohol, since the Tobacco did not have significant samples