A narrative review on the role of hesperidin on metabolic parameters, liver enzymes, and inflammatory markers in nonalcoholic fatty liver disease.

Insulin resistance, oxidative stress, hyperlipidemia, and inflammation play main roles in the development of nonalcoholic fatty liver disease (NAFLD). Some studies have reported that hesperidin can reduce hyperglycemia and hyperlipidemia by inhibiting inflammatory pathways. In the current study, our purpose was to evaluate whether it can influence the primary parameters in NAFLD and improve the treatment effectiveness for future trials. Various studies have found that hesperidin involves multiple signaling pathways such as cell proliferation, lipid and glucose metabolism, insulin resistance, oxidative stress, and inflammation, which can potentially affect NAFLD development and prognosis. Recent findings indicate that hesperidin also regulates key enzymes and may affect the severity of liver fibrosis. Hesperidin inhibits reactive oxygen species production that potentially interferes with the activation of transcription factors like nuclear factor-κB. Appropriate adherence to hesperidin may be a promising approach to modulate inflammatory pathways, metabolic indices, hepatic steatosis, and liver injury.

Neurocognitive and behavioral abnormalities in Indian children with sleep-disordered breathing before and after adenotonsillectomy.

OBJECTIVES: Children with untreated sleep-disordered breathing (SDB) have impaired intellectual ability and behavioral effects. Timely treatment of SDB by adenotonsillectomy (AT) may prevent this morbidity. This study was designed to assess the prevalence of neurocognitive and behavioral dysfunction in Indian children with SDB and to evaluate the impact of AT. METHODS: Children recruited underwent diagnostic polysomnography (PSG), a detailed neurocognitive and behavioral assessment using a battery of validated instruments - the Malin's Intelligence Scale (MIS) for Indian children, Modified Wisconsin's Card Sorting Test, Parent Conners' Scale, and the Childhood Behavior Checklist (6-18). These children then underwent AT and subsequent reassessment at 3 and 6 months. RESULTS: Neurocognitive impairment was common among the 33 enrolled children (mean age 9 [±2.97] years; 78.8% males). There was a significant correlation between the lowest O2saturation and the "categories completed" (r = -0.379; P = 0.029); and the lowest O2saturation and the "failure to maintain sets" (r = 0.386; P = 0.026) of the Modified Wisconsin's Card Sorting Test. Postsurgery, although apnea-hypopnea index (AHI) significantly decreased after surgery, 15 children still had SDB. Mean scores of most of the tested neurocognitive and behavioral domains showed improvement, although residual deficits were prevalent even after 6 months. Patients with a baseline AHI >5/h and those who had complete resolution of SDB (postoperative AHI <1/h) showed improvement in more subscales than patients with baseline AHI < 5/h and patients with incomplete resolution of SDB. CONCLUSION: The decreased neurocognitive performance related to SDB may be a result of hypoxemia, rather than the frequency of SDB events. Despite AT, residual disease is common and such patients may require further treatment.

Spontaneous resolution of nitrofurantoin-induced chronic pulmonary toxicity presenting with respiratory failure.

Nitrofurantoin is one of the most common drugs implicated in drug-induced pulmonary toxicities, the manifestations of which range from dose-independent acute self-limiting reactions to chronic dose-dependent pathologies. The severity of these pulmonary adverse effects may range from trivial hypersensitivity reactions to extensive and irreversible lung fibrosis leading to respiratory failure and death. Symptomatic and supportive treatment in addition to discontinuation of the drug usually suffices for the management of mild reactions. Corticosteroids have been traditionally used to relieve the symptoms and hasten the resolution of pulmonary lesions in case of severe toxicities. However conclusive evidence in the form of controlled studies in favor of this routine use is lacking. We report a case of an elderly lady who presented to us in respiratory failure due to nitrofurantoin induced chronic lung disease. The patient's symptoms and blood gas abnormalities resolved spontaneously over the course of 6 months after stopping the drug. Radiological lesions including those suggestive of apparently permanent fibrosis also resolved during this time. Corticosteroids, inhalational or systemic, were not used. Spontaneous normalization of clinico-radiological features in nitrofurantoin induced chronic lung disease presenting with respiratory failure has rarely been reported previously. The related literature is also reviewed.

Metabolic changes in normal- and underweight children with obstructive sleep-disordered breathing.

OBJECTIVE: This study evaluates the metabolic profile of normal- and underweight children with sleep-disordered breathing (SDB) due to adenotonsillar hypertrophy. METHODS: A total of 39 children aged 3-15 years with SDB and 28 age- and gender-matched controls were included in the study. Body mass index z score, blood pressure, and fasting serum levels of triglycerides (TGs), high-density lipoprotein (HDL), low-density lipoprotein (LDL), total cholesterol, very-low-density lipoprotein (VLDL), blood glucose, plasma insulin, and homeostatic model assessment (HOMA) were determined in both case patients and controls. RESULTS: We observed significantly lower levels of fasting blood glucose (p = 0.015) and higher levels of HDL (p = 0.002), LDL (p = 0.002), and cholesterol (p = 0.001) in case patients than in controls. The mean values of fasting insulin and HOMA were higher in case patients (6.42 ± 6.47 and 1.40 ± 1.48) than in controls (5.31 ± 3.40 and 1.20 ± 0.84) respectively. No direct correlation between indices of severity of SDB and various metabolic and blood pressure parameters was found. When the effect of body weight was studied by subgrouping case patients according to normal weight and underweight, significant increases in the levels of fasting insulin (p = 0.039), HOMA (p = 0.017), and fasting blood glucose (p = 0.021) were observed. Also, a significant correlation was observed between the duration of illness and fasting insulin (p = 0.023), HOMA (p = 0.020), fasting glucose (p = 0.004), and diastolic blood pressure (p = 0.030). CONCLUSION: This study shows an independent effect of body weight and duration of illness on various metabolic and blood pressure parameters in normal- and underweight children with SDB.

Bronchioloalveolar cell carcinoma presenting as a "non-resolving consolidation" for two years.

Bronchioloalveolar carcinoma (BAC), a rare form of lung malignancy, is usually seen in non-smokers and women. Three distinct histological forms have been identified viz, mucinous, non-mucinous and mixed or indeterminate. The mucinous variety of BAC may present as a consolidation which is very difficult to differentiate from an infective pneumonia. We present a case of a middle aged female who was evaluated for a "non-resolving consolidation" for a period of two years. She had undergone an inconclusive bronchoscopy and had received several courses of antibiotics including anti-tuberculous therapy without relief. The size of the lesion had remained largely unchanged during this period and there was no significant clinical deterioration in the patient. Transbronchial biopsy done on presentation revealed BAC of the mucinous variety. BAC presenting as a large consolidation without significant change for a period of two years has rarely been documented in the literature.

Impact of allergic rhinitis in school going children.

Allergic rhinitis (AR) is the most common chronic pediatric disorder. The International Study for Asthma and Allergies in Childhood phase III found that the global average of current rhinoconjunctivitis symptoms in the 13-14 year age-group was 14.6% and the average prevalence of rhinoconjunctivitis symptoms in the 6-7 year age-group was 8.5%. In addition to classical symptoms, AR is associated with a multidimensional impact on the health related quality of life in children. AR affects the quality of sleep in children and frequently leads to day-time fatigue as well as sleepiness. It is also thought to be a risk factor for sleep disordered breathing. AR results in increased school absenteeism and distraction during class hours. These children are often embarrassed in school and have decreased social interaction which significantly hampers the process of learning and school performance. All these aspects upset the family too. Multiple co-morbidities like sinusitis, asthma, conjunctivitis, eczema, eustachian tube dysfunction and otitis media are generally associated with AR. These mostly remain undiagnosed and untreated adding to the morbidity. To compound the problems, medications have bothersome side effects which cause the children to resist therapy. Children customarily do not complain while parents and health care professionals, more often than not, fail to accord the attention that this not so trivial disease deserves. AR, especially in developing countries, continues to remain a neglected disorder.

Allergic bronchopulmonary aspergillosis in a patient with chronic obstructive pulmonary disease.

Allergic bronchopulmonary aspergillosis (ABPA) is a debilitating lung disease which occurs as a result of interplay between a variety of host and environmental factors. It occurs in certain susceptible individuals who develop hypersensensitivity to the colonised Aspergillus species. ABPA is a complicating factor in 2% of patients with asthma and is also seen in patients with cystic fibrosis. Asthma and chronic obstructive pulmonary disease (COPD) are known to share key elements of pathogenesis. It is well known that ABPA can occur in patients with asthma, but it has recently been reported in patients with COPD as well. We report a 55-year-old male ex-smoker who presented with complaints of exertional breathlessness and productive cough for five years and an episode of haemoptysis four days prior to presentation. Spirometery showed airflow obstruction which was not reversible with bronchodilators. Chest CT scan revealed paraseptal emphysema along with central bronchiectasis (CB) in the right upper lobe and bilateral lower lobes. A type I skin hypersensitivity reaction to Aspergillus species was elicited. He fulfilled the serological criteria for ABPA and was diagnosed as having concomitant COPD and ABPA-CB. The patient was initiated on therapy for COPD along with oral corticosteroids, on which he had remarkable symptomatic improvement.