BACKGROUND Non-alcoholic fatty liver disease(NAFLD)increases the risk of cardiovascular diseases independently of other risk factors.However,data on its effect on cardiovascular outcomes in coronavirus disease 2019(CO...BACKGROUND Non-alcoholic fatty liver disease(NAFLD)increases the risk of cardiovascular diseases independently of other risk factors.However,data on its effect on cardiovascular outcomes in coronavirus disease 2019(COVID-19)hospitalizations with varied obesity levels is scarce.Clinical management and patient care depend on understanding COVID-19 admission results in NAFLD patients with varying obesity levels.AIM To study the in-hospital outcomes in COVID-19 patients with NAFLD by severity of obesity.METHODS COVID-19 hospitalizations with NAFLD were identified using International Classification of Disease-10 CM codes in the 2020 National Inpatient Sample database.Overweight and Obesity Classes Ⅰ,Ⅱ,and Ⅲ(body mass index 30-40)were compared.Major adverse cardiac and cerebrovascular events(MACCE)(all-cause mortality,acute myocardial infarction,cardiac arrest,and stroke)were compared between groups.Multivariable regression analyses adjusted for sociodemographic,hospitalization features,and comorbidities.RESULTS Our analysis comprised 13260 hospitalizations,7.3% of which were overweight,24.3% Class Ⅰ,24.1% Class Ⅱ,and 44.3% Class Ⅲ.Class Ⅲ obesity includes younger patients,blacks,females,diabetics,and hypertensive patients.On multivariable logistic analysis,Class Ⅲ obese patients had higher risks of MACCE,inpatient mortality,and respiratory failure than Class Ⅰ obese patients.Class Ⅱ obesity showed increased risks of MACCE,inpatient mortality,and respiratory failure than Class I,but not significantly.All obesity classes had non-significant risks of MACCE,inpatient mortality,and respiratory failure compared to the overweight group.CONCLUSION Class Ⅲ obese NAFLD COVID-19 patients had a greater risk of adverse outcomes than class Ⅰ.Using the overweight group as the reference,unfavorable outcomes were not significantly different.Morbid obesity had a greater risk of MACCE regardless of the referent group(overweight or Class Ⅰ obese)compared to overweight NAFLD patients admitted with COVID-19.展开更多
Background and Aims: Lifestyle (exercise and dietary) modification is the mainstay of treatment for non-alcoholic fatty liver disease (NAFLD). However, there is paucity of data on effect of intensity of exercise in ma...Background and Aims: Lifestyle (exercise and dietary) modification is the mainstay of treatment for non-alcoholic fatty liver disease (NAFLD). However, there is paucity of data on effect of intensity of exercise in management of NAFLD, and we aimed to study the effect of variable intensities of exercise on NAFLD. Methods: The study was performed in the Department of Gastroenterology of the SCB Medical Col-lege, Cuttack and the Biju Patnaik State Police Academy, Bhu-baneswar. The subjects were police trainees [18 in a moderate intensity exercise group (MIG) and 19 in a low in-tensity exercise group (LIG)] recruited for a 6-month physical training course (261.8 Kcalorie, 3.6 metabolic equivalent in MIG and 153.6 Kcalorie, 2.1 metabolic equivalent in LIG). NAFLD was diagnosed by ultrasonography, with exclusion of all secondary causes of steatosis. All participants were eval-uated by anthropometry (weight, height, body mass index (BMI), waist circumference), assessed for blood pressure and biochemical parameters (blood glucose, liver function test, lipid profile, serum insulin), and subjected to transabdo-minal ultrasonography before and after 6 months of physical training, and the results were compared. Results: Both the groups had similar BMI, fasting plasma glucose, AST, gamma-glutamyl transpeptidase, insulin, and homeostatic model as-sessment-insulin resistance (known as HOMA-IR) (p>0.05). However, subjects in the LIG were older and had lower alanine transaminase, higher triglycerides and lower high-density lip-oproteins than MIG subjects. There was a significant reduc-tion in BMI (27.0±2.1 to 26.8±2.0;p=0.001), fasting blood glucose (106.7±21.6 to 85.8±19.0;p<0.001), serum trigly-cerides (167.5±56.7 to 124.6±63.5;p=0.017), total choles-terol (216.8±29.2 to 196.7±26.6;p=0.037), low-density lipoprotein cholesterol (134.6±21.4 to 130.5±21.9;p=0.010), serum aspartate transaminase (39.3±32.2 to 30.9±11.4;p<0.001), serum alanine transaminase (56.6 ±28.7 to 33.0±11.3;p<0.001) and HOMA-IR (2.63±2.66 to 1.展开更多
Background:The subclavian vein(SCV)is an alternative to the internal jugular vein when it is difficult to locate,such as in patients with hypovolemia or obesity.Ultrasonography(USG)guidance for SVC cannulation has evo...Background:The subclavian vein(SCV)is an alternative to the internal jugular vein when it is difficult to locate,such as in patients with hypovolemia or obesity.Ultrasonography(USG)guidance for SVC cannulation has evolved,resulting in fewer complications and higher first-pass success rates.This study aimed to compare the effectiveness and safety of SCV cannulation with USG-and landmark-guided techniques.Methods:In this prospective randomized interventional controlled study,80 patients admitted to the intensive care unit between July 2022 and October 2022 were randomly assigned to the landmark method group(LM group)and USG group.In the LM group,SCV cannulation was performed using the traditional landmark technique,whereas in the USG group,it was performed using USG guidance.The primary objective of this study was to evaluate the ease of subclavian central venous cannulation in critically ill patients using the 2 techniques.The secondary objectives were to compare the success rate of cannulation between these 2 techniques,evaluate the number of attempts,assess cannulation failure,and assess mechanical complications.Results:The first-pass success rates were 70%and 92.5%in the LM and USG groups,respectively(P<0.001).The average numbers of attempts in the LM and USG groups were 1.275(±0.520)and 1.075(±0.266),respectively(P=0.034).The average procedure durations were 7.45(±1.10)and 8(±0.933)minutes in the LM and USG groups(P=0.018),respectively.The rates of complications in both groups were not statistically significant.Conclusion:The USG guidance for SCV cannulation has an advantage over landmark-guided methods in a critical care setting.The SCV is a good alternative to internal jugular vein cannulation.The average time to cannulation was longer in the USG group than in the LM group,which can decrease with the frequent use of USG and increasing operator experience.Clinical trials:This study was registered in the Clinical Trials Registry-India(CTRI Trial No.CTRI/2022/07/043694,dated May 7,2022).展开更多
Meckel–Gruber syndrome(MGS)is a rare lethal congenital malformation affecting 1 in 13,250–140,000 live births.The classical diagnostic triad comprises multicystic dysplastic kidneys,occipital encephalocele,and posta...Meckel–Gruber syndrome(MGS)is a rare lethal congenital malformation affecting 1 in 13,250–140,000 live births.The classical diagnostic triad comprises multicystic dysplastic kidneys,occipital encephalocele,and postaxial polydactyly.It can variably be associated with other malformations such as cleft lip and palate,pulmonary hypoplasia,hepatic fibrosis,and anomalies of central nervous system.A 20 weeks fetus was diagnosed as MGS with classical features along with many other congenital abnormalities such as microcephaly,microphthalmia,hypertelorism,cleft lip and palate,neonatal teeth,and the right side club foot which were detected only after doing autopsy.This case is reported because of its rarity emphasizing the importance of neonatal autopsy in every case of fetal death,especially where the antenatal diagnosis has not been made previously.A systematic approach to accurate diagnosis of MGS based on autopsy will be described here which can allow recurrence risk counseling and proper management in future pregnancies.展开更多
文摘BACKGROUND Non-alcoholic fatty liver disease(NAFLD)increases the risk of cardiovascular diseases independently of other risk factors.However,data on its effect on cardiovascular outcomes in coronavirus disease 2019(COVID-19)hospitalizations with varied obesity levels is scarce.Clinical management and patient care depend on understanding COVID-19 admission results in NAFLD patients with varying obesity levels.AIM To study the in-hospital outcomes in COVID-19 patients with NAFLD by severity of obesity.METHODS COVID-19 hospitalizations with NAFLD were identified using International Classification of Disease-10 CM codes in the 2020 National Inpatient Sample database.Overweight and Obesity Classes Ⅰ,Ⅱ,and Ⅲ(body mass index 30-40)were compared.Major adverse cardiac and cerebrovascular events(MACCE)(all-cause mortality,acute myocardial infarction,cardiac arrest,and stroke)were compared between groups.Multivariable regression analyses adjusted for sociodemographic,hospitalization features,and comorbidities.RESULTS Our analysis comprised 13260 hospitalizations,7.3% of which were overweight,24.3% Class Ⅰ,24.1% Class Ⅱ,and 44.3% Class Ⅲ.Class Ⅲ obesity includes younger patients,blacks,females,diabetics,and hypertensive patients.On multivariable logistic analysis,Class Ⅲ obese patients had higher risks of MACCE,inpatient mortality,and respiratory failure than Class Ⅰ obese patients.Class Ⅱ obesity showed increased risks of MACCE,inpatient mortality,and respiratory failure than Class I,but not significantly.All obesity classes had non-significant risks of MACCE,inpatient mortality,and respiratory failure compared to the overweight group.CONCLUSION Class Ⅲ obese NAFLD COVID-19 patients had a greater risk of adverse outcomes than class Ⅰ.Using the overweight group as the reference,unfavorable outcomes were not significantly different.Morbid obesity had a greater risk of MACCE regardless of the referent group(overweight or Class Ⅰ obese)compared to overweight NAFLD patients admitted with COVID-19.
基金This study was sponsored by the Kalinga Gastroenterology Foundation,Cuttack,Odisha
文摘Background and Aims: Lifestyle (exercise and dietary) modification is the mainstay of treatment for non-alcoholic fatty liver disease (NAFLD). However, there is paucity of data on effect of intensity of exercise in management of NAFLD, and we aimed to study the effect of variable intensities of exercise on NAFLD. Methods: The study was performed in the Department of Gastroenterology of the SCB Medical Col-lege, Cuttack and the Biju Patnaik State Police Academy, Bhu-baneswar. The subjects were police trainees [18 in a moderate intensity exercise group (MIG) and 19 in a low in-tensity exercise group (LIG)] recruited for a 6-month physical training course (261.8 Kcalorie, 3.6 metabolic equivalent in MIG and 153.6 Kcalorie, 2.1 metabolic equivalent in LIG). NAFLD was diagnosed by ultrasonography, with exclusion of all secondary causes of steatosis. All participants were eval-uated by anthropometry (weight, height, body mass index (BMI), waist circumference), assessed for blood pressure and biochemical parameters (blood glucose, liver function test, lipid profile, serum insulin), and subjected to transabdo-minal ultrasonography before and after 6 months of physical training, and the results were compared. Results: Both the groups had similar BMI, fasting plasma glucose, AST, gamma-glutamyl transpeptidase, insulin, and homeostatic model as-sessment-insulin resistance (known as HOMA-IR) (p>0.05). However, subjects in the LIG were older and had lower alanine transaminase, higher triglycerides and lower high-density lip-oproteins than MIG subjects. There was a significant reduc-tion in BMI (27.0±2.1 to 26.8±2.0;p=0.001), fasting blood glucose (106.7±21.6 to 85.8±19.0;p<0.001), serum trigly-cerides (167.5±56.7 to 124.6±63.5;p=0.017), total choles-terol (216.8±29.2 to 196.7±26.6;p=0.037), low-density lipoprotein cholesterol (134.6±21.4 to 130.5±21.9;p=0.010), serum aspartate transaminase (39.3±32.2 to 30.9±11.4;p<0.001), serum alanine transaminase (56.6 ±28.7 to 33.0±11.3;p<0.001) and HOMA-IR (2.63±2.66 to 1.
文摘Background:The subclavian vein(SCV)is an alternative to the internal jugular vein when it is difficult to locate,such as in patients with hypovolemia or obesity.Ultrasonography(USG)guidance for SVC cannulation has evolved,resulting in fewer complications and higher first-pass success rates.This study aimed to compare the effectiveness and safety of SCV cannulation with USG-and landmark-guided techniques.Methods:In this prospective randomized interventional controlled study,80 patients admitted to the intensive care unit between July 2022 and October 2022 were randomly assigned to the landmark method group(LM group)and USG group.In the LM group,SCV cannulation was performed using the traditional landmark technique,whereas in the USG group,it was performed using USG guidance.The primary objective of this study was to evaluate the ease of subclavian central venous cannulation in critically ill patients using the 2 techniques.The secondary objectives were to compare the success rate of cannulation between these 2 techniques,evaluate the number of attempts,assess cannulation failure,and assess mechanical complications.Results:The first-pass success rates were 70%and 92.5%in the LM and USG groups,respectively(P<0.001).The average numbers of attempts in the LM and USG groups were 1.275(±0.520)and 1.075(±0.266),respectively(P=0.034).The average procedure durations were 7.45(±1.10)and 8(±0.933)minutes in the LM and USG groups(P=0.018),respectively.The rates of complications in both groups were not statistically significant.Conclusion:The USG guidance for SCV cannulation has an advantage over landmark-guided methods in a critical care setting.The SCV is a good alternative to internal jugular vein cannulation.The average time to cannulation was longer in the USG group than in the LM group,which can decrease with the frequent use of USG and increasing operator experience.Clinical trials:This study was registered in the Clinical Trials Registry-India(CTRI Trial No.CTRI/2022/07/043694,dated May 7,2022).
文摘Meckel–Gruber syndrome(MGS)is a rare lethal congenital malformation affecting 1 in 13,250–140,000 live births.The classical diagnostic triad comprises multicystic dysplastic kidneys,occipital encephalocele,and postaxial polydactyly.It can variably be associated with other malformations such as cleft lip and palate,pulmonary hypoplasia,hepatic fibrosis,and anomalies of central nervous system.A 20 weeks fetus was diagnosed as MGS with classical features along with many other congenital abnormalities such as microcephaly,microphthalmia,hypertelorism,cleft lip and palate,neonatal teeth,and the right side club foot which were detected only after doing autopsy.This case is reported because of its rarity emphasizing the importance of neonatal autopsy in every case of fetal death,especially where the antenatal diagnosis has not been made previously.A systematic approach to accurate diagnosis of MGS based on autopsy will be described here which can allow recurrence risk counseling and proper management in future pregnancies.
