Peer leader perspectives from a PLTL implementation in a Hispanic-serving institution.

Peer-Led Team Learning (PLTL) is a pedagogical approach that has been shown to benefit all students, especially underrepresented minority students and peer leaders in Science, Technology, Engineering, and Mathematics (STEM) disciplines. In this work, we present results from our study of the impact of PLTL on our peer leaders from a controlled implementation in general biology, general chemistry, and statistics courses at a Hispanic-serving, minority-serving institution. More specifically, we have measured our PLTL program's impact on our peer leaders' skill development, engagement with the subject material, and sense of belonging as peer leaders. Weekly peer leader reflections analyzed using the Dreyfus model exhibited a consistent set of skills, while those analyzed using the Pazos model revealed a consistent type of student-peer leader interactions, allowing for peer leaders to be assigned to specific levels in the hierarchy of each of the models. Analysis of eight skill-based Likert-scale questions on the SALG survey showed an overall positive shift at the highest level. Independent of the skill or interaction level of the peer leader, we observed several instances of peer leaders acknowledging development in their communication skills, sincere attempts at creating an engaging classroom, and a deep investment in their student's success. Peer leaders also reported improvements in understanding of the subjects they were teaching, wanting to persevere and solve problems independently, and feeling passionate about helping other students.

Steroids as rescue therapy for vitamin A-induced acute liver failure.

Antioxidant drugs form one of the mainstay therapies for pain management in chronic pancreatitis. Heightened oxidative stress and free radical activity is the target for the use of antioxidant therapy in chronic pancreatitis pain relief. One of the chief components of these drugs is beta-carotene, and vitamin A. Vitamin A is a proven hepatotoxic agent which can lead to liver injury ranging from acute hepatitis to cirrhosis. Here, we present a case of chronic pancreatitis who continued antioxidant therapy unsupervised for 7 years and developed vitamin A-induced acute liver failure, which was treated with prednisolone.

Terlipressin-induced ischaemic skin necrosis.

Terlipressin is a commonly used drug in hepatology practice for the two most serious complications of cirrhosis, that is, acute oesophageal variceal bleed and hepatorenal syndrome. Acute-on-chronic liver failure (ACLF) is a medical emergency and is frequently associated with acute kidney injury (AKI). Two male patients with alcohol-induced ACLF with high MELD (Model for End-Stage Liver Disease) score presented with AKI. Both were treated with terlipressin infusion. There was no response to terlipressin in these sick patients, and further both patients developed ischaemic skin necrosis and succumbed to multiorgan failure. Continuous infusion of terlipressin is superior to bolus dosing, but we noted that continuous infusion might as well be associated with severe adverse effects in patients with a high MELD score. More extensive prospective studies, including patients with high MELD score, are required to ascertain the safety of terlipressin.

Metadoxine Versus Placebo for the Treatment of Non-alcoholic Steatohepatitis: A Randomized Controlled Trial.

OBJECTIVE AND DESIGN: The study aimed at assessing the therapeutic efficacy and safety of metadoxine versus placebo on the ultrasonographic and histological features of non-alcoholic steatohepatitis (NASH). SUBJECTS: 134 subjects with biopsy-confirmed NASH were randomized to receive metadoxine 500 mg two times daily (n = 75) or placebo (n = 59) added to the standard of care, over 16 weeks. EFFICACY ENDPOINTS: Originally, the primary efficacy endpoint was the composite of: reduction in the steatosis by ≥1 grade, reduction in hepatic necro-inflammation by ≥1 grade and ALT normalization. Since >50% of patients refused the second biopsy, it was decided to analyze only the individual parameters. RESULTS: There was no significant difference between the treatment and the placebo groups in either liver histology or ALT or AST. Overall, as expected both groups showed reduction in serum ALT and AST compared to baseline. Compared to placebo (9 out 54), patients on metadoxine (34 out of 75) had significantly higher rates of improvement in 1-point in steatosis grade on ultrasound (P-value <0.001). Safety and tolerability did not differ between treatments. CONCLUSION: Metadoxine is not effective in improvement of liver histology or serum ALT or AST in patients with NASH. However, there was significant improvement of steatosis assessed by ultrasound. To properly estimate the effects on histology and transaminases, further studies of longer duration and at higher doses are needed.