Combined effects of synbiotic and sitagliptin versus sitagliptin alone in patients with nonalcoholic fatty liver disease

BACKGROUND/AIMS: Non-alcoholic fatty liver disease (NAFLD) is one of the most prevalent chronic liver diseases in recent years. The aim of this study was to evaluate the effects of sitagliptin with and without a synbiotic supplement in the treatment of patients with NAFLD. METHODS: In total, 138 NAFLD patients aged 18-60 years were enrolled in the study. Patients were randomized to one of the following treatments for 16 weeks: Group I (n=68), sitagliptin 50 mg daily plus placebo (one capsule per day) or group II (n=70) sitagliptin 50 mg daily plus synbiotic (one capsule per day). Changes in fasting blood glucose (FBS), liver enzymes, lipid profile, and body mass index were compared between the groups. RESULTS: The mean change in FBS with sitagliptin-placebo from baseline was -10.47±5.77 mg/dL, and that with sitagliptin-synbiotic was -13.52±4.16 mg/dL. There was a significant difference between the groups (P < 0.001). The mean change in cholesterol (Chol) was -8.34±28.83 mg/dL with sitagliptin-placebo and -21.25±15.50 mg/dL with sitagliptinsynbiotic. There was a significant difference between the two groups (P=0.029). The administration of sitagliptin-placebo induced an increase of 6.13±27.04 mg/dL in low density lipoprotein (LDL), whereas sitagliptin-synbiotic induced a decrease of 14.92±15.85 mg/dL in LDL. A significant difference was observed between the two groups (P < 0.001). On the other hand, in the sitagliptin-synbiotic group, there was significant improvement in aspartate aminotransferase (AST) level compared to the sitagliptin-placebo group (P=0.018). CONCLUSIONS: Sitagliptin-synbiotic produced greater improvement in FBS, AST, Chol, and LDL compared to sitagliptin alone in patients with NAFLD.

A high serum-ascites albumin gradient and mediastinal fibrosarcoma

Accumulation of free fluid in the peritoneal cavity is called ascites. The first step in identifying its etiology is to determine the serum-ascites albumin gradient [SAAG]. According to this parameter, a high SAAG is regarded as a gradient greater than 1.1 g/dL. This condition has some differential diagnoses such as liver cirrhosis, Budd-Chiari syndrome, heart failure, and idiopathic portal fibrosis. In the present article, we present a young man with abdominal distention due to a high SAAG. Further evaluation of the abdominal and thoracic cavity revealed a mass in the posterior mediastinum, which had compressed the inferior vena cava and left atrium and led to Budd-Chiari syndrome. Evaluation of the biopsy sample showed fibrosarcoma. Mediastinal fibrosarcomas, though rare, should be considered in the differential diagnosis of mediastinal masses

[Association between serum iron, ferritin, hemoglobin and hemostatic state with short term mortality in primary intracerebral hemorrhage]

Background and Objectives: despite the high mortality and morbidity resulted from intracerebral hemorrhage [ICH], there is no definite cure for this type of stroke. This obvious disability rate necessitates some clinical and laboratory criteria to anticipate the short-term outcome. This study aimed to compare some blood and hemostatic indices between two groups with live and death outcomes

Materials and Methods: the subjects for this cohort study were selected via a consecutive based hospitalization. They were 90 patients with confirmed acute primary ICH [by CT scan]. These patients divided into two groups, as live or dead at the end of the first week following ICH. All of the laboratory and clinical data were analyzed using independent T-test and the variance comparison test

Results: we studied 90 patients that consisted of 47 men and 43 women. Global comparison showed without considering gender, there were significant differences between two live and dead groups in the platelet count, iron, ferritin and ICH score. In the male group there was a significant difference in ferritin, Hb and ICH score between dead and live groups. Also in the female sub group, iron, ferritin and ICH score evinced meaningful difference among the two outcomes

Conclusion: higher levels of iron and ferritin are related to short-term mortality in ICH patients