Assessment of CT perfusion indices of the clinicoradiological response to anti-tubercular therapy in patients with intestinal tuberculosis.

AIM: To explore the possibility of using a novel technique, CT perfusion imaging, to monitor the response to anti-tubercular therapy (ATT) in patients with intestinal tuberculosis. MATERIALS AND METHODS: A prospective observational study was performed in adults with treatment naive-intestinal tuberculosis. Clinical, endoscopic, and conventional radiological findings of patients were compared at baseline and post-ATT. CT perfusion imaging was performed with recording of six perfusion parameters (blood flow, blood volume, mean transit time, time to peak, maximum peak intensity, and permeability/blood flow extraction). RESULTS: Twenty-two patients (13 women, 59%) with a median age of 25 years were recruited. The terminal ileum and ileocaecal junction were the most frequent sites of involvement (59%), with multiple segments of the intestine being involved in 16 patients (73%). Median duration of ATT was 6 months (range 6-10 months). Complete clinical response was observed in 22/22 (100%) patients, endoscopic response in 12/12 (100%) patients, and radiological response in 10/13 (76%) patients. There was a significant decrease in mean blood flow, blood volume, maximum peak intensity, and an increase in mean transit time and time to peak on follow-up CT perfusion imaging performed after 6 months of ATT. CONCLUSION: Significant alterations in CT perfusion parameters were demonstrated following treatment, consistent with a decline in inflammation and vascularity. CT perfusion imaging of the bowel is a novel means to assess the radiological response to ATT in intestinal tuberculosis, although at the cost of a higher dose of radiation exposure.

Effect of probiotics and humate substances on blood parameters, intestinal development and immune organs of growing quail.

This study aimed to evaluate impacts of dietary probiotics (Bacillus subtilis PB6) and humate substances (HS) supplementation on histomorphometry of small intestine and immune organs, blood parameters of growing quail. A total of 216 unsexed quails (seven days old) were randomly distributed to six groups. The 1st group did not receive any supplements (control), 2nd group received B. subtilis (CloSTAT: 0.5 g/kg diet), 3rd and 4th groups received HS (4 and 8 g/kg diet, respectively), 5th and 6th groups received CloSTAT + 4g HS and CloSTAT + 8g HS, respectively. Results showed that the inclusion of B. subtilis alone in quail diets significantly improved histomorphometry indices of intestine and immune organs compared to the control. Dietary supplementation of HS alone led to deteriorating histomorphometry indices of intestinal segments and immune organs compared to the control. CloSTAT, HS or both improved lipid profile and antioxidant parameters. Serum mineral levels did not differ significantly among groups except for Ca levels. In conclusion, dietary probiotics supplementation enhanced histomorphometry of intestine and immune organs and improved serum Ca, lipid profile and antioxidant indices. Moreover, the addition of HS (4 or 8 g/kg diet) improved lipid profile and antioxidant indices, but led to undesirable results in intestinal development and immune organs.

Endoscopic management of acute oesophageal variceal bleeding within 12 hours of admission is superior to 12-24 hours.

Background: Acute oesophageal variceal haemorrhage (AOVH) is a medical emergency. The American Association for the Study of Liver Diseases recommends endoscopy management as soon as possible and not more than 12 hours after presentation. The United Kingdom guidelines recommended endoscopy for unstable patients with severe acute upper gastrointestinal bleeding immediately after resuscitation and within 24 hours of admission. We aimed to evaluate the outcome of endoscopic management of AOVH in less than 12 hours compared to 12-24 hours post admission.Methods: 297 patients with AOVH were divided into groups depending on the timing of the endoscopic management: 180 within 12 h of admission and 117 patients at 12-24 hours of admission. Routine clinical and laboratory data were collected.Results: Compared to patients with endoscopic management at 12-24 hours (mean 16 hours), patients with endoscopic management within 12 hours (mean 8.3 hours) of admission had fewer hospital stay days (P = 0.001), significant reduction of ammonia levels (P < 0.0001) and significant improvement in associated hepatic encephalopathy grade 25 (p = 0.048). There were no major clinical events in the 12-hour group, but 8 events in the 12-24 hour group (p < 0.01).Conclusion: Endoscopic management of acute variceal bleeding within 12 hours of admission is superior to endoscopic management at 12-24 hours of admission regarding reduction of hospital stay, ammonia levels, correction of hepatic encephalopathy, re-bleeding and mortality rate, hence, reducing the cost of treatment benefiting patient satisfaction and improving hospital bed availability.

Marrow outside marrow: imaging of extramedullary haematopoiesis.

Extramedullary haematopoiesis (EMH) refers to the formation of non-neoplastic blood cell lines outside the bone marrow and is a common incidental finding when patients with haematological disorders are imaged. EMH presenting as mass (tumefactive EMH) has long been a radiological conundrum as it resembles neoplasms. Several imaging findings have been described in EMH, and these vary depending on the activity of the underlying haematopoiesis. The older lesions are easier to diagnose as they often demonstrate characteristic findings such as haemosiderin and fat deposition. In comparison, the newer, actively haematopoietic lesions often mimic neoplasms. Molecular imaging, particularly 99mTc labelled sulphur colloid scintigraphy, may be helpful in such cases. Although imaging is extremely useful in detecting and characterising EMH, imaging alone is often non-diagnostic as no single mass shows all the typical findings. Hence, a judgement based on the clinical background, combination of imaging findings, and slow interval growth may be more appropriate and practical in making the correct diagnosis. In every case, an effort has to be made in providing an imaging-based diagnosis as it may prevent a potentially risky biopsy. When confident differentiation is not possible, biopsy has to be resorted to. This article describes the causes, pathophysiology, and theories underlying the genesis of EMH, followed by the general and location-specific imaging findings. The purpose is to provide a thorough understanding of the condition as well as enable the clinical radiologist in making an imaging-based diagnosis whenever possible and identify the situations where biopsy has to be performed.

Prostate biopsy: when and how to perform.

Prostate cancer, unlike other cancers, has been sampled in a non-targeted, systematic manner in the past three decades. On account of the low volume of prostate sampled despite the multiple cores acquired, systematic transrectal (TRUS) biopsy suffered from low sensitivity in picking up clinically significant prostate cancer. In addition, a significant number of cancers of the anterior, lateral peripheral zone, and the apex were missed as these areas were undersampled or missed during this biopsy protocol. Subsequently, the number of cores acquired was increased with special focus given to targeting the previously undersampled areas. These procedures led to an increase in the complication rates as well as detection of more clinically insignificant cancers. The advent of multiparametric magnetic resonance imaging (MRI) and its high intrinsic tissue contrast enabled better detection of prostate cancer. This led to the introduction of MRI-targeted biopsies with either MRI-TRUS fusion or under direct (in-gantry) guidance. MRI-targeted biopsies increased the percentage of positive cores and detection of clinically significant prostate cancers; however, these are expensive, time-intensive, require significant capital investment and operator expertise. This article describes the indications, workflow, complications, advantages, and disadvantages of TRUS-guided biopsy followed by MRI-guided biopsies.

Effect of dietary sodium butyrate supplementation on growth, blood biochemistry, haematology and histomorphometry of intestine and immune organs of Japanese quail.

New strategies must be developed to improve poultry performance and health. One of these strategies is the use of supplementations as sodium butyrate (SB) to improve the physiological status and then increasing the growth performance, but the best period of age in which the addition of SB is more effective on birds is not well understood. Therefore, the aim of this study was to investigate the effect of dietary inclusion of SB supplementation through the first, second or whole growth period on some physiological indices and growth performance of growing Japanese quail. In total, 240 unsexed 1-day-old quail chicks were divided into four groups (three replicates per group of 20 chicks in each). The first group was fed basal diet without SB from 1 to 42 days (control, T1), while SB at a rate of 1 g/kg basal diet was mixed with the feed of the 2nd, 3rd and 4th groups of chicks from 1 to 21 days (SB 1 to 21, T2), 1 to 42 days (SB 1 to 42, T3) and 22 to 42 days (SB 22 to 42, T4) of age, respectively. The results stated that addition of SB significantly improved live BW at 21 days, feed conversion ratio (FCR) and BW gain (BWG) during 1 to 21 days in T2 and T3 groups compared to T1 and T4 groups. During the whole period, group T3 had higher BWG and better FCR than the other groups (T1, T2 and T4). At 21 days, no significant differences among all treatments were detected on haematology and serum biochemistry except total protein and cholesterol. At 42 days, SB supplementation significantly improved most serum constituents, haematological parameters, villus height and width of intestine and morphometry of immune organs. The group fed SB throughout the experiment (T3) showed the best results. In conclusion, it is recommended feeding quail on diets containing SB through the whole growth period to show its affirmative impact on the growth and physiological indices.

Serum leptin and homeostasis model assessment-IR as novel predictors of early liver fibrosis in chronic hepatitis B virus infection.

BACKGROUND: The relationship between hepatitis B virus (HBV) infection, leptin and insulin resistance remains unclear. We hypothesised links between serum leptin and insulin resistance in non-diabetic patients with chronic viral hepatitis B infection and their relation to liver fibrosis. METHODS: We recruited 190 untreated patients with chronic HBV infection and 72 healthy controls. Serum leptin, fasting glucose, insulin, liver function tests (LFTs), C-peptide and Homeostasis model assessment-IR (HOMA-IR) were measured/calculated by ELISA and standard techniques. RESULTS: Serum leptin, C-peptide (both P < 0.001), HOMA-IR (P = 0.021) and several LFTs were increased in patients with chronic HBV-infection. In multivariate regression analysis, both HOMA-IR (P = 0.003) and leptin (P = 0.002) were significant independent predictors of HBV infection. There were significant positive correlations (P < 0.01) between leptin and HOMA-IR (r = 0.81), between serum leptin and METAVIR activity (r = 0.95), and between HOMA-IR and BMI (r = 0.75), fasting glucose (r = 0.005), and fasting insulin (r = 0.81). Several LFTs, glucose and insulin correlated modestly (r = 0.61-0.69, P < 0.05) with leptin. CONCLUSION: Serum leptin may be related to the rate of fibrosis progression in nondiabetic patients with chronic HBV infection. Follow-up by serial measurement of serum leptin and HOMA-IR in non diabetic HBV-infected patients may be used as a non-invasive marker of early liver fibrosis.

Can combined blood neutrophil to lymphocyte ratio and C-reactive protein be used for diagnosis of spontaneous bacterial peritonitis?

BACKGROUND AND OBJECTIVE: Spontaneous bacterial peritonitis (SBP) is diagnosed by the presence of ≥250 polymorphonuclear neutrophils (PMN)/mm3 in the ascites and the absence of surgically treatable cause of intra-abdominal infection. Blood neutrophil lymphocytic ratio (NLR) is an inexpensive and simple test for inflammation. C-reactive protein (CRP) is an inflammatory marker used for the diagnosis and follow-up of many diseases and morbidities. We aimed to evaluate the clinical utility of combined blood NLR and CRP as a non-invasive test for SBP diagnosis. METHODS: Blood NLR was calculated, and CRP value determined in 180 cirrhotic patients with ascites (126 with and 54 without SBP). Sensitivity and specificity of combined blood NLR and CRP values for SBP diagnosis were estimated by receiver operator characteristic curve. RESULTS: Both blood NLR and CRP values were significantly higher in SBP (p < 0.001). For SBP diagnosis, a blood NLR of >2.89 had a sensitivity 80.3% and specificity 88.9%. CRP >11.3 mg/dL had a sensitivity 88.9% and specificity 92.6%. In logistic regression analysis, combined blood NLR and CRP had a sensitivity 95.1% and specificity 96.3% at the same cut off values. CONCLUSIONS: Combined NLR and CRP could be used as a novel, simple, low-cost, non-invasive test for SBP diagnosis.

Urotensin II: lessons from comparative studies for general endocrinology.

The importance of combining studies across vertebrates to provide insights into the functionality of hormone systems is considered, using recent advances in Urotensin II (UII) biology to illustrate this. The impact of genome analyses on understanding ligand and UII receptor (UT) structures is reviewed, noting their high conservation from fish to mammals. The early linkage of UII with fish osmoregulatory physiology drove our investigation of possible renal actions of UII in mammals. The kidney is a potential major source of UII in mammals and endogenous peptide appears to have tonal influence over renal excretion of water and electrolytes. Blockade of UII actions by administration of UT receptor antagonist, urantide, in anaesthetised rats, indicates that endogenous UII lowers renal filtration rates and excretion of water and ions. These effects are considered in relation to apparent association of UII with a number of human cardiovascular and renal disorders. Following up the sequencing of UT in mammals here we contrast the first fish UT sequences with those in other species. It is now evident that UT expression in fish osmoregulatory tissues, such as the gill and kidney, exhibits considerable plasticity in response to physiological challenge, providing an important component of the adaptive organismal responses. A number of areas of UII research, which will continue to benefit from moving questions between appropriate vertebrate groups, have been highlighted. These comparative approaches will yield improved understanding and further novel actions of this intriguing endocrine and paracrine system, so highly conserved across the vertebrate series.

Urotensin II and renal function in the rat.

Urotensin II (UII) is a potent vasoactive hormone in mammals. However, despite its well-known effects on epithelial sodium transport in fish, little is known about its actions on the mammalian kidney. The aim of this study was to determine the effects of UII on renal function in the rat. Using standard clearance methods, the effects of rUII and the rat UII receptor (UT) antagonist, urantide, were studied. UII was measured in plasma and urine by radioimmunoassay. UII and UT were localized in the kidney by immunohistochemistry and mRNA expression quantified. Rat urinary [UII] was 1,650-fold higher than that in plasma. Immunoreactive-UII was localized to the proximal tubules, outer and inner medullary collecting ducts (IMCD); UT receptor was identified in glomerular arterioles, thin ascending limbs, and IMCD. UII and UT mRNA expression was greater in the medulla; expression was higher still in spontaneously hypertensive rats (SHRs) associated with raised plasma (UII). Injection of rUII induced reductions in glomerular filtration rate (GFR), urine flow, and sodium excretion. Urantide infusion resulted in increases in these variables. Endogenous UII appears to contribute to the regulation of GFR and renal sodium and water handling in the rat. While hemodynamic changes predominate, we cannot rule out the possibility of a direct tubular action of UII. Increased expression of UII and UT in the SHR suggests that UII plays a role in the pathophysiology of cardiovascular disease.

Coordination properties of cefadroxil antibiotic: synthesis and equilibrium studies of the binary and ternary complexes involving amino acids and DNA units.

The formation equilibria for the binary complexes of Cu(II), Ni(II), Co(II), Zn(II), Mn(II), Hg(II), Cd(II), Ca(II), and Mg(II) with cefadroxil (Cef) and for the ternary complexes Cu(Cef)(L), where L refers to amino acid or DNA, were investigated. The protonation constants of cefadroxil and formation constants of the formed complexes were determined at 25 degrees C and mu = 0.1 M NaNo(3). Cooper(II) and cobalt(II) complexes of cefadroxil were isolated in solid state and characterized by elemental analysis, infrared and electronic spectral, conductivity and magnetic measurement.