Coexistent Alcohol-Related Liver Disease and Alcohol-Related Pancreatitis: Analysis of a Large Health Care System Cohort

INTRODUCTION

Although coexistence of alcohol-related liver disease (ALD) and pancreatitis (ALP) is seen in clinical practice, a clear understanding of the overlap between these diseases is lacking. Moreover, the relative risks for certain population groups have not been studied. We determined the prevalence and coexistence of ALD and ALP in patients with an alcohol use disorder using retrospective analysis of a large patient cohort from Western Pennsylvania. We specifically emphasized the analysis of underrepresented populations, including women and blacks.

METHODS

We identified all unique patients who received care in UPMC health system during 2006-2017 with at least one International Classification of Diseases versions 9 and/or 10 codes for alcohol misuse, ALD and pancreatitis. We noted their sex, race and age of first diagnosis and duration of contact.

RESULTS

Among 89,774 patients that fit our criteria, the prevalence of ALD, ALP and coexistent ALD and ALP in patients with alcohol misuse was 11.7%, 7.4% and 2.5%, respectively. Prevalence of ALP in ALD was 16.4%, and ALD in ALP was 33.1%. Prevalence of ALP in ALD was slightly more prevalent in women (18.6% vs. 15.6%, p < 0.001). Prevalence of ALP in ALD was 2-4 folds greater in blacks than other races.

DISCUSSION

A sizeable fraction of patients with ALD or ALP has coexistent disease. This is the first study to identify that blacks are at a higher risk for ALP in the presence of ALD. Future studies should define the clinical impact of coexistent disease on clinical presentation and short- and long-term outcomes.

Practical consensus recommendations on ovarian suppression in early breast cancer (adjuvant)

Substantial survival benefits exist for patients with early-stage breast cancer who undergo treatment with single-modality ovarian suppression, but its value is uncertain. Expert oncologist discussed to determine whether additional benefits exist with ovarian suppression plus multiple adjuvant therapy which provides a new treatment option that reduces the risk of recurrence in early breast cancer. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at this practical consensus recommendations for the benefit of community oncologists.

Coexistence of alcohol-related pancreatitis and alcohol-related liver disease: A systematic review and meta-analysis

BACKGROUND

Available estimates of coexistent alcohol-related pancreatitis (ALP) and alcohol-related liver disease (ALD) vary widely, and factors that determine coexistent disease are largely unknown. We performed a systematic review of published literature with the primary aim to generate robust estimates for coexistent alcohol-related chronic pancreatitis (ACP) and alcohol-related cirrhosis (ALC).

METHODS

We searched PubMed, EMBASE, and Web of Science databases from inception until February 2018. Studies included were those in English-language, sample size ≥25 and allowed calculation of the coexistent disease. Pooled estimates were calculated using a random-effects model approach.

RESULTS

Twenty-nine (including 5 autopsy studies) of 2000 eligible studies met inclusion criteria. Only 6.9% included patients were female. Fifteen studies enabled calculation of ACP in ALC, and 11 for ALC in ACP. Pooled prevalence of ACP in ALC was 16.2% (95% CI 10.4-24.5) overall, and 15.5% (95% CI 8.0-27.7) when data were limited to clinical studies. Corresponding prevalence for ALC in ACP was 21.5% (95% CI 12.0-35.6) and 16.9% (95% CI 11.5-24.3), respectively. There was significant heterogeneity among studies (I² - 65-92%). Pooled prevalence for ALP in ALD or ALD in ALP in clinical studies were 15.2% and 39%, respectively. None of the studies reported outcomes in patients with coexistent disease.

CONCLUSION

A sizeable fraction of patients with ACP or ALC have coexistent disease. Future studies should define the prevalence of coexistent disease in women and minority populations, and the consequences of coexistent disease on clinical presentation and short- and long-term outcomes.

A Microwave-Induced Thermoacoustic Imaging System With Non-Contact Ultrasound Detection

Portable and easy-to-use imaging systems are in high demand for medical, security screening, nondestructive testing, and sensing applications. We present a new microwave-induced thermoacoustic imaging system with non-contact, airborne ultrasound (US) detection. In this system, a 2.7 GHz microwave excitation causes differential heating at interfaces with dielectric contrast, and the resulting US signal via the thermoacoustic effect travels out of the sample to the detector in air at a standoff. The 65 dB interface loss due to the impedance mismatch at the air-sample boundary is overcome with high-sensitivity capacitive micromachined ultrasonic transducers with minimum detectable pressures (MDPs) as low as 278 μ Pa _rms and we explore two different designs-one operating at a center frequency of 71 kHz and another at a center frequency of 910 kHz. We further demonstrate that the air-sample interface presents a tradeoff with the advantage of improved resolution, as the change in wave velocity at the interface creates a strong focusing effect alongside the attenuation, resulting in axial resolutions more than 10× smaller than that predicted by the traditional speed/bandwidth limit. A piecewise synthetic aperture radar (SAR) algorithm modified for US imaging and enhanced with signal processing techniques is used for image reconstruction, resulting in mm-scale lateral and axial image resolution. Finally, measurements are conducted to verify simulations and demonstrate successful system performance.

The utility of pulmonary function testing in predicting outcomes following liver transplantation

Although pulmonary function tests (PFTs) are routinely performed in patients during the evaluation period before liver transplantation (LT), their utility in predicting post-LT mortality and morbidity outcomes is not known. The aim of this study was to determine the impact of obstructive and/or restrictive lung disease on post-LT outcomes. We conducted a retrospective analysis of patients who had pre-LT PFTs and underwent a subsequent LT (2007-2013). We used statistical analyses to determine independent associations between PFT parameters and outcomes (graft/patient survival, time on ventilator, and hospital/intensive care unit [ICU] length of stay [LOS]). A total of 415 LT recipients with available PFT data were included: 65% of patients had normal PFTs; 8% had obstructive lung disease; and 27% had restrictive lung disease. There was no difference in patient and graft survival between patients with normal, obstructive, and restrictive lung disease. However, restrictive lung disease was associated with longer post-LT time on ventilator and both ICU and hospital LOS (P < 0.05). More specific PFT parameters (diffusing capacity of the lungs for carbon monoxide, total lung capacity, and residual volume) were all significant predictors of ventilator time and both ICU and hospital LOS (P < 0.05). Although pre-LT PFT parameters may not predict post-LT mortality, restrictive abnormalities correlate with prolonged post-LT ventilation and LOS. Efforts to identify and minimize the impact of restrictive abnormalities on PFTs might improve such outcomes. Liver Transplantation 22 805-811 2016 AASLD.

Rapid recovery after early initiation of plasmapheresis in atypical Hemolytic Uremic Syndrome (aHUS) : A case report

We report a case of a thirteen year old female diagnosed as aHUS, complicated by malignant hypertension and central nervous system involvement. The patient was treated with plasmapheresis(plasma exchange) and corticosteroids along with supportive care. The patient showed remission immediately and recovered after four weeks of hospital stay and three months later is well on antihypertensives.

Effects of moderate-to-vigorous intensity physical activity on overnight and next-day hypoglycemia in active adolescents with type 1 diabetes

OBJECTIVE

Physical activity (PA) provides many benefits to adolescents with type 1 diabetes; however, these individuals tend to have lower fitness and PA levels than their disease-free counterparts. The purpose of this study was to examine the acute temporal associations between moderate-to-vigorous intensity PA (MVPA) and hypoglycemia (continuous glucose monitor [CGM] reading ≤70 mg/dL).

RESEARCH DESIGN AND METHODS

Nineteen participants (53% females) 14-20 years old with type 1 diabetes were recruited. Participant fitness was evaluated via indirect calorimetry using a maximal exercise test; body composition was measured using air displacement plethysmography. An accelerometer was worn continuously (3-5 days) and acceleration data used to estimate MVPA (minutes per day). Blood glucose values were simultaneously tracked using CGM. Controlling for sex, percent body fat (%BF), fitness, and concurrent MVPA, the likelihood of nighttime and next-day hypoglycemia due to MVPA was examined using logistic regression.

RESULTS

Participants were of average fitness (females: 43.9 mL/kg/min; males: 49.8 mL/kg/min) and adiposity (females: 26.2%; males: 19.2%); 63.2% met the U.S. federal guideline of accumulating 60 min/day of MVPA. Hypoglycemia was 31% more likely in those who accumulated 30 min/day more MVPA in the previous afternoon than those with less (95% CI 1.05-1.63; P = 0.017).

CONCLUSIONS

The results suggest that participating in afternoon MVPA increases the risk of overnight and next-day hypoglycemia, independent of sex, %BF, fitness, and concurrent MVPA. While promoting PA as a healthy behavior, it is important to educate adolescents with type 1 diabetes on prevention of hypoglycemia following PA.

Comparison of mechanical and chemomechanical methods of caries removal in deciduous and permanent teeth: a SEM study

BACKGROUND

Mechanical method of caries removal is associated with the removal of sound tooth structure, production of pain, heat, annoying sounds, and vibrations. Chemomechanical caries removal method is based on removal of only carious dentin leaving sound dentin intact.

AIM

The aim of this study was to compare the efficacy of mechanical and chemomechanical methods of caries removal in deciduous and permanent teeth.

STUDY DESIGN

A total of 30 carious teeth including 15 deciduous and 15 permanent teeth having dentinal caries selected randomly and cut into two halves through center of the lesion, were subjected to caries removal by mechanical (Group A), and chemomechanical methods (Group B). Time taken for removal of caries was noted with stopwatch. Samples were prepared and seen under the scanning electron microscope for the presence of bacterial colonies. Data were analyzed using statistical package for social sciences (SPSS) Software.

RESULTS

No significant difference was found for the presence of bacterial colonies in both groups of deciduous and permanent teeth; however, time taken for caries removal by the chemomechanical method was twice than the mechanical method.

CONCLUSION

despite the insignificant presence of bacterial colonies and twice time taken as compared to mechanical method, chemomechanical method was easy to introduce, was painless, did not form smear layer and conserved the sound tooth structure.

'Layer by layer' phacoemulsification in posterior polar cataract with pre-existing posterior capsular rent

PURPOSE

To evaluate a new technique of 'Layer by Layer' phacoemulsification in eyes with posterior polar cataract with pre-existing posterior capsular rent (PCR).

METHODS

Layer by layer phacoemulsification was performed in eight eyes of eight patients of posterior polar cataract with pre-existing posterior capsular rent. All the patients had evidence of a posterior capsular defect showing presence of iridescent refractile lens particles in vitreous with onion skinning of central dense plaque.

RESULTS

The mean age of the patients was 43.75+/-2.5 years and six patients were men. All the eyes had vertical posterior capsular defect irrespective of the site of entry of phaco probe. Vitrectomy was not required in any of the eyes. Single piece foldable acrylic intraocular lens was implanted in the bag in all the eyes. The mean preoperative best corrected visual acuity was 0.14+/-0.05, which improved to 0.77+/-0.27.

CONCLUSION

Our technique of 'Layer by layer' phacoemulsification is an effective and safe technique for the management of posterior polar cataract with pre-existing PCR.

Immunoglobulin profile in mycetoma

Serum samples obtained from 25 patients of mycetoma caused by Madurella mycetomi in 18, Streptomyces somaliensis in 5, Streptomyces madurae and streptomyces palletierii from 1 each and also from 25 healthy controls were evaluated for immunoglobulins IgG, IgM and IgA by radial immunodiffusion method using tripartigen plates. All the three classes of immunoglobulins showed increased concentration in cases of mycetoma by M. mycetomi and S. pelletierii. The raised levels of IgG and IgM in cases of mycetoma caused by S. madurae and S. somaliensis where bones were involved, were not statistically significant. IgA was consistently high in all cases of mycetoma irrespective of causative agent and tissue involved. These alterations may possibly reflect relatively poor IgG and IgM response in individuals with extension of mycetoma lesion to bones.

The indirect platelet suspension immunofluorescence test in the detection of platelet antibodies in idiopathic thrombocytopenic purpura

Among the various techniques developed for the detection of platelet antibodies, the platelet suspension immunofluorescence test has been reported to be simple, sensitive and reproducible, and therefore more clinically useful than other techniques available. An initial evaluation of the test was carried out for the detection of platelet autoantibodies in ten cases of idiopathic thrombocytopenic purpura. The indirect PSIFT was found to be positive in 60%. The technical aspects of the test and the problems encountered are discussed.

The prevalence of markers for hepatitis B and human immunodeficiency viruses, malarial parasites and microfilaria in blood donors in a large hospital in south India

Blood donors (35,395) were screened at the CMC Hospital, Vellore, in South India during the 2-year period from July 1986 to June 1988. They were either relatives of patients (referred to as replacement donors) or volunteers. Paid or professional donors were not accepted. Of the replacements 21.5% and of the voluntary donors 9.7% were rejected. Mean donor age was 32.2 years and the commonest blood group was O (39.46%), Rh positive (93.93%). Hepatitis B surface antigen was found in 1.37% and 2.96% of voluntary and replacement donors respectively. Anti-HIV antibodies were found in 1.9/1000 donors. This shows an increasing prevalence of HIV infection in the Indian donor population not reported earlier. The prevalences of malarial parasites and microfilaria in replacement donors were 0.02 and 1.62% respectively. In voluntary donors, malarial parasites were not found and microfilaria were found in only 0.15%. All rejection criteria except low haemoglobin were significantly more frequent among replacement donors than among voluntary donors. In the light of these results, screening of all donor blood for HBsAg and Anti-HIV by the most sensitive techniques and for malarial and filarial parasites in endemic areas is essential.

Mucosal lesions in the rat associated with the attachment of Moniliformis (Acanthocephala)

By means of scanning electron microscopy, aspects of the attachment of Moniliformis dubius (Acanthocephala) to the intestinal wall of the rat are described together with various changes in the structure and form of the mucosa. Attachment of the parasite results in the formation of a distinct pit around the everted proboscis and a crater around the neck. Contact between the anterior region of the trunk of the worm and the intestine of the host appears to lead to villous fusion so that characteristic grooves are formed in the mucosal tissue. Evidence was also obtained to suggest that host goblet cells may become exhausted during the course of an infection with Moniliformis.

Rat-dietary fructose and the intestinal distribution and growth of Moniliformis (Acanthocephala)

The numbers, distribution in the small intestine, sexual development and growth (dry weight) of 5-week-old Moniliformis dubius (Acanthocephala) were investigated experimentally in adult, female CFHB rats fed on theoretically isoenergetic diets containing known amounts of fructose in combination with either maize-oil fatty acids or maize oil and two concentrations of casein. There was no obvious development of M. dubius when there was no fructose in the host's diet. In contrast, estimated consumption by the host of as little as about 2 g of fructose during the 5-week infection period was accompanied by marked sexual dimorphism and weight gain in most of the M. dubius present. The dry weights of M. dubius of both sexes were positively correlated with fructose concentrations ranging from 0 to 2.5% (w/w) in the diets containing fatty acids. Significant, but not substantial, increases in M. dubius dry weight were observed as the dietary fructose concentration was raised to 12% (w/w). Similar trends were observed when the fructose was offered to the infected rats with maize oil, but in general, fructose added to the fatty-acid based diets supported most M. dubius growth. Differences in the distribution pattern of the worms in rats fed on the fatty-acid or maize-oil based diets were observed and their possible significance is discussed.