The Effects of a Short-Term Combined Exercise Program on Liver Steatosis Indices and the Lipidemic and Glycemic Profile in NAFLD Individuals: A Pilot Study.

Non-alcoholic fatty liver disease (NAFLD) is a very common liver disease associated with obesity, unhealthy diet, and lack of physical exercise. Short-term aerobic or resistance exercise has been shown to result in reduced liver fat in patients with NAFLD; however, the impact of the combination of these types of exercise has received less attention. This study investigated the effect of a short-term (7 days) concurrent exercise training program performed daily on liver steatosis indices, as well as the glycemic and lipidemic profile of overweight/obese sedentary volunteers. Twenty adult patients (age: 47.3 ± 12.3 yrs, body mass index: 32.4 ± 3.4 kg/m2) with NAFLD, detected by ultrasound and hematological indices, participated in the study. Pre- and post-exercise intervention assessment included body weight (BW), waist circumference (WC), hip/waist ratio (H/W), Homeostasis Model Assessment Insulin Resistance (HOMA-IR), blood lipids, and steatosis indices. Fatty Liver Index, Lipid Accumulation Index, WC, H/W, triglycerides, and total cholesterol were improved (p < 0.05) post-exercise, while no differences (p > 0.05) were observed in BW, HOMA-IR, HDL, LDL, Hepatic Steatosis Index, and Framingham Steatosis Index compared to pre-exercise values. It is concluded that a 7-day combined exercise program can have beneficial effects on hepatic steatosis and central adiposity indices, independently of weight loss, in patients with NAFLD.

Factors associated with treatment failure in patients with diabetic foot infections: An analysis of data from randomized controlled trials.

BACKGROUND: Although several antibiotics have been studied for the treatment of foot infections, their effectiveness has been considered to be similar. The scope of this analysis was the identification of factors that are associated with treatment failure based on evidence from randomized controlled trials (RCTs). METHODS: Two reviewers independently extracted data from published RCTs comparing different antibiotics for diabetic foot infections (DFIs). RESULTS: The combined observed treatment failure was 22.7% in the 18 RCTs included in the analysis. When different regimens of various antibiotics (penicillins, carbapenems, cephalosporins, and fluoroquinolones) were directly compared in the individual RCTs, they were associated with similar frequency of treatment failure. However, when all patients were combined, carbapenems were associated with fewer treatment failures. Also, treatment failure in patients with DFIs from whom methicillin-resistant S. aureus (MRSA) alone or as part of a polymicrobial infection was isolated was more common than in patients from whom other bacteria were isolated [24/68 (35.3%) versus 350/1522 (23%), p=0.02]. Among patients with DFIs due to MRSA the use of linezolid was not associated with better effectiveness in comparison to other antibiotics [treatment failure: 6/19 (31.6%) versus 18/49 (36.7%), p=0.69]. Of interest, treatment failure was similar in patients with and without osteomyelitis [44/169 (26.5%) versus 330/1424 (23.2%), p=0.34]. CONCLUSIONS: The isolation of MRSA seems to be a significant factor associated with treatment failure in patients with DFIs. Further research efforts are needed for the identification of additional risk factors for treatment failure and optimization of the management of patients with DFIs.

Frequency and predictors of colonization of the respiratory tract by VIM-2-producing Pseudomonas aeruginosa in patients of a newly established intensive care unit.

The aim of this study was to examine the frequency and predictors of colonization of the respiratory tract by metallo-beta-lactamase (MBL)-producing Gram-negative bacteria in patients admitted to a newly established intensive care unit (ICU) of a tertiary care hospital. Specimens of tracheobronchial aspirates for microbiological studies were obtained every day for the first 3 days of the ICU stay and subsequently every third day for the rest of the ICU stay. PCR analysis and nucleotide sequencing were performed to identify bacteria that had MBL genes. Thirty-five patients (20 male, 15 female) were hospitalized during the initial 3 month period of functioning of the ICU. Colonization of the lower respiratory tract by Gram-negative bacteria was found in 29 of 35 patients (83 %) during the first 6-20 days (median 13 days) following admission to the ICU (13 patients with Acinetobacter baumannii, ten with Pseudomonas aeruginosa, three with Enterobacter aerogenes, two with Klebsiella pneumoniae and one with Stenotrophomonas maltophilia). Six of 29 patients (21 %) colonized with Gram-negative bacteria had bla(VIM-2)-positive P. aeruginosa isolates; one of these patients developed clinical infection due to this micro-organism. Previous use of carbapenems (P=0.01) or other beta-lactams (P=0.03), as well as a stay in the ICU of >20 days (P<0.001), were associated with colonization with bla(VIM-2)-producing P. aeruginosa. In conclusion, colonization by Gram-negative bacteria of the respiratory tract of patients in this newly established ICU was common (83 %). Use of beta-lactams, including carbapenems, was associated with subsequent colonization of the respiratory tract with MBL-positive P. aeruginosa.