Effect of Long-Term Hydroxytyrosol Administration on Body Weight, Fat Mass and Urine Metabolomics: A Randomized Double-Blind Prospective Human Study.

Hydroxytyrosol (HT) is a natural antioxidant found in olive products and characterized by well-documented beneficial effects on human health. Several research studies are ongoing that aim to investigate its potency and molecular mechanism of action. The present study aimed to investigate the potential effect of HT on human obesity through a randomized double-blind prospective design. HT in two different doses (15 and 5 mg/day) and a placebo capsule was administered to 29 women with overweight/obesity for six months and their weight and fat mass were monitored at three time points (baseline, 4, 12 and 24 weeks). Statistically significant weight and visceral fat mass loss (%weight loss: p = 0.012, %visceral fat loss: p = 0.006) were observed in the group receiving the maximum HT dosage versus placebo after 4 weeks of the intervention, with attenuation of these findings at 12 and 24 weeks of the study. Urine samples were collected during the intervention and analyzed via liquid chromatography-high-resolution mass spectrometry for untargeted metabolomic purposes and comparisons between study groups were performed. HT administration was safe and well-tolerated. To the best of our knowledge, this is the first human cohort investigating the effects of HT on obesity for a prolonged study period.

Meningitis-Retention Syndrome.

Meningitis-retention syndrome (MRS) is a clinical entity that has recently appeared in the literature. We present the case of a 22-year-old man with fever and headache who, in the course of his hospitalization with a diagnosis of aseptic meningitis, developed acute urinary retention. Fewer than 30 such cases have been described and in several of them, no clear associations with other disorders have been made. In some cases, direct association with viral infection has been proved, and in others, there are indications of an underlying demyelinating condition. To further complicate the issue, various conditions such as Elsberg syndrome and acute disseminated encephalomyelitis, which not only have some similarities but also have some distinct differences, have been placed under the umbrella definition of MRS. In our review, we attempt to address these conditions and better define MRS by establishing diagnostic criteria based on what has thus far been described in the literature.

Multiple cranial nerve palsies in giant cell arteritis and response to cyclophosphamide: a case report and review of the literature.

Giant cell arteritis (GCA) has been previously associated with cranial mononeuritis (usually optic neuritis). We hereby describe a 68-year-old man who presented due to fever and diplopia of acute onset. Physical examination revealed left abducens nerve palsy and a hearing defect in the right ear. Brain imaging and cerebrospinal fluid analysis were not diagnostic. GCA was suspected, and treatment with high-dose methylprednisolone was initiated, leading to marked improvement. Temporal artery biopsy confirmed the presence of GCA. While considering corticosteroid tapering, the patient experienced hoarseness due to right laryngeal nerve palsy. Addition of cyclophosphamide to the treatment resulted in full response. GCA mainly affects large vessels, but one or more cranial nerve palsies may also occur. Following a review of the literature, this is the first report of three cranial nerve palsies in the setting of histologically proven GCA. The role of cyclophosphamide in this entity is also discussed.

Dogma disputed: postdialysis increase of aminotransferase values cannot be attributed to an inhibitor removal by hemodialysis.

The objective of this study was to assess changes of aspartate aminotransferase (AST [serum glutamic oxalacetic transaminase]) and alanine aminotransferase (ALT [serum glutamic pyruvic transaminase]) values after a hemodialysis (HD) session. Aspartate aminotransferase and ALT serum values were measured before and after a 4 h HD session in 37 stable patients (group A), before and after a 3.5 h isovolemic HD (IVHD, with a zero ultrafiltration rate) session in eight patients (group B), as well as before and after a session of "isolated ultrafiltration" (IUF) in eight more patients (group C). In group A, mean predialysis AST and ALT serum values that were 16.4 ± 4.3 and 16.0 ± 5.5 IU/L, increased to 20.1 ± 5.4 and 17.7 ± 6.2 IU/L, respectively (p < 0.0001, comparing pre- to postdialysis values, for both). When the postdialysis values were corrected for hemoconcentration induced by ultrafiltration, no differences were found in ALT values. However, postdialysis-corrected AST values (mean 17.7 ± 4.4 IU/l) remained higher compared with predialysis values (p < 0.001). The AST/ALT ratio was 1.13 ± 0.4 for predialysis values and 1.26 ± 0.5 for postdialysis values (p < 0.0001). Predialysis mean serum AST and ALT values did not show any difference after the 3.5 h IVHD sessions (group B), but increased significantly (p < 0.02) after the removal of 1.7 ± 0.2 L of fluid by IUF (group C). In chronic HD patients, postdialysis serum AST and ALT values increased significantly compared with predialysis values. This increment is mainly due to hemoconcentration induced by ultrafiltration and cannot be attributed to the removal of an aminotransferase inhibitor by HD.

Subtherapeutic serum vancomycin concentrations during on-line hemodiafiltration.

The aim of the study is to study vancomycin serum concentration changes during on-line hemodiafiltration (OL-HDF) and determine whether administration of vancomycin during the last hour of OL-HDF provides therapeutic serum concentrations. Vancomycin was administered intravenously at a dose of 15 mg/kg to 17 chronic hemodialysis patients who were enrolled into two study groups (A and B). In group A patients (n = 11), vancomycin was administered immediately postdialysis. Forty-three hours later, a 4-hour OL-HDF session was performed. Blood samples (S) for vancomycin measurement were drawn before, during, and after the session. In group B patients (n = 6), vancomycin was administered during the last hour of a 4-hour OL-HDF session on Monday. Vancomycin serum concentrations were measured postdialysis, as well as before and after the next two dialysis sessions of the week. In group A patients, mean vancomycin concentrations were reduced by 50% (S(pre): 10.2 ± 1.4 µg/ml, S(post): 5.0 ± 0.9 µg/ml). Vancomycin dialysance was 74.6 ± 29.3 ml/min, while the volume of distribution was 0.42 L/kg. In group B patients, mean vancomycin concentrations before the beginning of Wednesday and Friday dialysis sessions were 3.1 ± 0.7 and 1.4 ± 0.4 µg/ml, respectively. Postdialysis administration of vancomycin followed by OL-HDF resulted in a 50% reduction of vancomycin serum concentrations. Administration during the last treatment hour of OL-HDF results in subtherapeutic vancomycin serum concentrations over the course of the subsequent inter- and intradialytic intervals.

Lipoprotein abnormalities in hemodialysis and continuous ambulatory peritoneal dialysis patients.

Lipid abnormalities are important variables in the development of vascular atherosclerotic lesions in ESRD patients while Lp(a) represents an independent risk factor. In order to evaluate lipid changes in HD and CAPD patients, serum cholesterol (TC), HDLc, LDLc, TG, apolipoproteins (AI,AII,B,E), Lp(a), and albumin levels were estimated in 109 ESRD dialyzed patients, 46 in HD and 63 in CAPD (mean duration 50 +/- 40 and 25 +/- 19 months, respectively), and 45 volunteers with high serum levels of C and TG, without renal insufficiency. Both HD and PD group revealed statistically significantly higher levels than controls for TC, TG, LDL-C, Apo-B,-E, while HDL-C levels were significantly lower. Except for the lower serum albumin levels in both dialyzed groups after six months lower ApoAI levels and higher ApoB levels were observed in HD and PD patients respectively. Lp(a) levels remained unchanged in HD group, while a statistically significant increase appeared in PD patients that was negative correlated with the decreased serum albumin levels. These results indicate that renal replacement modalities result in a different effect in lipoprotein metabolism that may play an important role in atherosclerotic vascular disease of dialyzed ESRD patients.

Is arterial hypertension an underlying factor in the increased serum Lp(a) levels in ESRD dialyzed patients?

Except for the disorders in lipoprotein metabolism several other factors have been involved in the development of atherosclerotic changes in ESRD patients, including arterial hypertension. Serum lipid profile (total cholesterol (TC), triglycerides (TG), apolipoproteins (AI,AII,B,E) and Lp(a)) was evaluated in 109 ESRD dialyzed patients, 46 in HD and 63 in CAPD and 45 hyperlipidemic patients without renal failure (HL-group). According to the presence of arterial hypertension the dialyzed patients were divided in two groups: group A of 42 hypertensive patients, (mean age 62.3 +/- 15.5 years), which were satisfactorily controlled with anti-hypertensive medication, and group B of 67 non-hypertensive patients, (mean age 66.6 +/- 11.9 years). Lp(a) levels were statistically significantly higher than HL group in both HD (p = 0.001) and PD (p < 0.05) patients. Besides, by dividing HD and PD group in hypertensive and non-hypertensive patients, Lp(a) levels were statistically significantly higher in hypertensive patients, while such a difference was not observed among non-renal failure patients. These results indicate that arterial hypertension may play an important role in Lp(a) serum titles, in ESRD patients undergoing either HD or PD.

Arterial Hypertension Is Associated with Increased Serum Lipoprotein(a) Levels in End-Stage Renal Disease Patients.

In addition to disorders in lipoprotein metabolism, several other factors are involved in the development of atherosclerotic changes in end-stage renal disease (ESRD) patients. One of these is arterial hypertension. We evaluated serum lipids-total cholesterol (TC), triglycerides (TG), apolipoproteins (AI , A II , B, E), lipoprotein(a) [Lp(a)]-in 109 ESRD patients on dialysis [46 on hemodialysis (HD); 63 on continuous ambulatory peritoneal dialysis (CAPD)] and in 45 hyperlipidemic patients without renal failure (HL group). Dialysis patients were divided in two groups. Group A included 42 hypertensive patients (mean age: 62.3 ± 15.5 years) whose blood pressure (BP) was satisfactorily controlled with anti-hypertensive medications. Group B included 67 non hypertensive patients (mean age: 66.6 ± 11.9 years). Levels of Lp(a) were significantly higher in both the HD (p = 0.001) and the CAPD (p < 0.05) patients as compared with the HL group. When the HD and CAPD groups were divided into hypertensive and non hypertensive patients, Lp(a) levels were significantly higher in the hypertensive patients; this difference was not observed among non renal failure patients. These results indicate that arterial hypertension is associated with elevated Lp(a) serum levels in ESRD patients undergoing either HD or CAPD.