Effect of vitamin D on stress-induced hyperglycaemia and insulin resistance in critically ill patients.

AIM: Effects of vitamin D supplementation on the glycaemic indices and insulin resistance in diabetic and non-diabetic patients were studied. In this study, effects of vitamin D supplementation on stress-induced hyperglycaemia and insulin resistance were evaluated in non-diabetic surgical critically ill patients. METHODS: Adult surgical patients with stress-induced hyperglycaemia within the first 24 h of admission to the ICU were recruited. The patients randomly assigned to receive either vitamin D or placebo. Patients in the vitamin D group received a single dose of 600,000 IU vitamin D3 as intramuscular injection at time of recruitment. Besides demographic and clinical characteristics of the patients, plasma glucose, insulin, 25(OH) D and adiponectin levels were measured at the time of ICU admission and day 7. Homoeostasis model assessment for insulin resistance (HOMA-IR) and homestasis model assessment adiponectin (HOMA-AD) ratio were considered at the times of assessment. RESULTS: Comparing with the baseline, plasma 25(OH) D level significantly increased in the subjects who received vitamin D (p = 0.04). Improvement in fasting plasma glucose levels was detected in day 7 of the study compared with the baseline status in both groups. HOMA-IR showed a decrement pattern in vitamin D group (p = 0.09). Fasting plasma adiponectin levels increased significantly in the vitamin D group (p = 0.007), but not in the placebo group (p = 0.38). Finally, changes in HOMA-AD ratio were not significant in the both groups. CONCLUSION: Vitamin D supplementation showed positive effect on plasma adiponectin level, as a biomarker of insulin sensitivity in surgical critically ill patients with stress-induced hyperglycaemia. However, effects of vitamin D supplementation on HOMA-IR and HOMA-AD as indicators of insulin resistance were not significant.

New onset idiosyncratic liver enzyme elevations with biological therapy in inflammatory bowel disease.

BACKGROUND: Anti-tumour necrosis factor α (anti-TNF) agents have been implicated in drug-induced liver injury. There is minimal data on this occurrence in inflammatory bowel disease (IBD) patients. AIM: To identify the characteristics of liver enzyme elevations following anti-TNF therapy initiation in IBD. METHODS: A retrospective cohort of patients initiating anti-TNF therapy were analysed for new onset alanine transaminase (ALT) elevation (≥60 U/L). We collected data on natural history, outcomes and patient characteristics compared with controls with persistent normal liver enzymes. Likelihood of causal association was assessed using the RUCAM score. RESULTS: From 1753 patients initiating an anti-TNF (1170 infliximab, 575 adalimumab, 8 certolizumab), 102 (6%) developed new onset ALT elevation. In 54 (53%), this could be linked to an alternate aetiology. Among those with idiopathic ALT elevations, the median time to ALT elevation from anti-TNF initiation was 18 weeks and median peak ALT was 96 U/L. Six underwent liver biopsy, all demonstrating hepatitis with autoimmune features. Compared to controls, cases were on a lower dose of infliximab (5.7 vs. 6.7 mg/kg, P = 0.02) but were otherwise similar in body mass index, sex and age. On follow-up, 34 continued the anti-TNF, 14 stopped therapy and 4 initiated steroids. Most (85%) normalised their LFTs after a median of 17 weeks including 28 (82%) of those who continued anti-TNF therapy. Ten patients were transitioned to a second anti-TNF without recurrence. CONCLUSIONS: ALT elevations occurred in 6% of IBD patients initiating anti-TNF therapy. Most idiopathic elevations were mild, transient and resolved despite therapy continuation.

Antimicrobial resistance pattern of gram-negative bacteria of nosocomial origin at a teaching hospital in the Islamic Republic of Iran.

The emergence of antimicrobial resistance is a global problem in the community and in hospitals. Antibiotic resistance of Gram-negative bacteria from nosocomial infections were evaluated during a 6-month period at Shariati teaching hospital, Tehran, Islamic Republic of Iran. Susceptibility tests were performed on 570 Gram-negative isolates obtained from clinical samples of patients infected after at least 72 hours stay in the hospital. Escherichia coli was the most frequently isolated Gram-negative organism (42.6%). The highest rate of resistance in Gram-negative isolates was seen in the intensive care unit, with Acinetobacter spp. as the most resistant organisms. Gentamicin was the most effective antibiotic against E. coli and all other isolates, while ciprofloxacin was also effective against a wide range of other species. Antibiotic resistant Gram-negative nosocomial infection is prevalent in this teaching hospital in Tehran.

Nutritional status and serum zinc and selenium levels in Iranian HIV infected individuals.

BACKGROUND: Human immunodeficiency virus infected individuals are prone to malnutrition due to increased energy requirements, enteropathy and increased catabolism. Trace elements such as zinc and selenium have major role in maintaining a healthy immune system. This study was designed to evaluate the nutritional status of Iranian subjects who were newly diagnosed with human immunodeficiency virus infection and to compare serum level of zinc and selenium in these patients with those of the sex and aged match healthy subjects. METHODS: After an interview and physical examination, nutritional assessment was done based on clinical and anthropometric parameters. Body mass index (normal range 18.5-27 kg/m2 based on age) of less than 16, 16-16.9 and 17-18.4 kg/m2 were considered as severe, moderate and mild malnutrition respectively. Serum level of zinc and selenium were measured by graphite furnace atomic absorption. RESULTS: Severe, moderate and mild malnutrition were detected in 15%, 38% and 24% of human immunodeficiency virus infected individuals respectively. Compared with the healthy control group, serum level of zinc and selenium in the human immunodeficiency virus infected subjects were significantly lower (P = 0.01 and P = 0.02 respectively). CONCLUSION: Malnutrition found to be prevalent in Iranian human immunodeficiency virus infected individuals and low serum zinc and selenium levels are common in this population.

Utilization and partition of dietary nitrogen in dairy cows fed grass silage-based diets.

Data from 207 production trials (998 treatment means) were used to study the effects of animal and dietary characteristics on the efficiency of N utilization for milk protein production, and on fecal N, urinary N, and total manure N output. The average efficiency of transferring dietary N to milk N (MNE; milk N/N intake) was 277 (SD = 36.0) g/kg. Nitrogen efficiency was poorly related to milk yield. Dietary concentrations of crude protein (CP) and protein balance in the rumen (PBV) were the best single predictors of MNE. Dietary CP concentration explained variation in MNE better than did N intake. Bivariate models with PBV or metabolizable protein (MP) explained the variation better than CP alone. The effects of protein feeding parameters on MNE were consistent among data subsets from studies investigating the effects of the amount and protein concentration of concentrate supplement, silage digestibility, silage fermentation quality, or substitution of grass silage with legume silage. The model with total dry matter and N intakes as independent variables explained fecal, urinary, and total manure N output more precisely than N intake alone. The model of fecal N output suggested that the true digestibility of dietary N was 0.91, and that metabolic and endogenous N was the major component in fecal N. The proportion of urine N in manure N was strongly related to dietary CP concentration. Including the concentration of dietary carbohydrates only slightly improved the models, indicating that the most effective strategy to improve MNE and to decrease N losses in manure, especially in urine, is to avoid feeding diets with excessively high CP concentration and especially excess ruminally degradable CP.

Effects of vegetable fats versus lard in milk replacers on feed intake, digestibility, and growth in Finnish Ayrshire bull calves.

The aim was to study whether vegetable fat mixtures could be used instead of lard [15.2% in dry matter (DM)] in milk replacers without impairing the performance of Finnish Ayrshire bull calves (n = 58). The growth performance of the calves was measured before and after weaning from 14 d to 6 mo of age. The following 3 fat sources in a milk replacer were studied: 1) a mixture of palm, coconut, and rapeseed oil, 2) palm and coconut oil, and 3) lard. The calves were bucket-fed 2 L of milk replacer 3 times per day. The milk replacer contained 116 g of DM/L, resulting in an average DM intake of 4.8 g of DM/kg of body weight0.75 (BW0.75) during the 8-wk trial, after which the calves were weaned. All the calves had free access to water, commercial starter, and grass silage before weaning. The weaned calves had free access to water and grass silage and were given 3 kg/d (air-dry basis) of a commercial concentrate mixture. The concentrate was replaced by barley when the bulls were 4.5 mo old. There were no significant differences between the diets in feed intake and apparent diet digestibility. The health and BW of the calves were similar during the study. The feed conversion rate (kg of DM intake/kg of gain) before weaning was significantly greater for the lard diet compared with the 2 vegetable fat mixtures. After weaning, the feed conversion rate was slightly lower for the diet that included the palm, coconut, and rapeseed oil mixture than for the diet that included palm and coconut oil mixture. The study showed that the 2 mixtures consisting solely of vegetable oils were effective dietary components, thus providing 2 alternative fat mixtures of milk replacers, for use instead of lard in formulating commercial calf milk replacers.

The effect of concentrate supplementation on nutrient flow to the omasum in dairy cows receiving freshly cut grass.

An experiment was carried out to determine the effect of increasing the amount of grain-based concentrate (0, 3, or 6 kg/d) on nutrient flow to the omasum, rumen fermentation pattern, milk yield, and nutrient use of dairy cows. Harvested timothy-meadow fescue grass was fed individually 3 times daily to 6 rumen-cannulated Holstein-Friesian cows in a duplicated 3 x 3 Latin square experiment. Grass was offered as 6 equal meals daily, and concentrates were fed as 2 equal meals daily. Nitrogen, microbial N, and neutral detergent fiber (NDF) flow from the rumen were measured using an omasal sampling technique in combination with a triple marker method [CoEDTA, Yb, and indigestible NDF (INDF) as markers]. Concentrate supplementation linearly decreased ruminal pH, N degradability, ammonia N concentration, and molar proportion of acetate and increased the molar proportion of butyrate. Supplementation of grass with concentrates linearly increased dry matter intake (DMI), microbial N synthesis, N, and NDF flow to the omasum, and ruminal and total tract NDF digestibility decreased linearly. Decreases in NDF digestibility in response to concentrates was primarily related to a decrease in the rate of digestion. Increased DMI overcame the negative effects of concentrate on NDF digestion, resulting in a linear increase in total metabolizable energy intake and milk production. Physical constraints were found not to limit grass DMI. Concentrate supplementation increased the apparent use of dietary N for milk production because of a reduction in N intake, rather than thorough improvements in N capture in the rumen.