Postprandial Hypertriglyceridemia Predicts Development of Insulin Resistance Glucose Intolerance and Type 2 Diabetes.

Insulin resistance (IR) and type 2 diabetes mellitus (T2DM) have been found to be associated with postprandial hypertriglyceridemia (PPHTg). However, whether PPHTg can cause IR and diabetes is not clear. We therefore investigated the role of PPHTg in development of T2DM in rat model of T2DM. 96 male Wistar rats were randomized into four groups (24 rats each). Control Group A, high sucrose diet (HSD) Group B, HSD+Pioglitazone (10 mg/kg/day) Group C and HSD+Atorvastatin (20 mg/kg/day) Group D. Fat and glucose tolerance tests were done at regular intervals in all groups besides insulin and body weight measurement. At 26 weeks, low dose streptozotocin (15 mg/kg, i.p.) was given to half of the rats. All rats were followed up till 48 weeks. PPHTg developed as early as week 2 in Group B and stabilized by week 14. Group B displayed highest PPHTg compared to other groups. Atorvastatin treatment (Group D) abolished PPHTg which became comparable to controls, pioglitazone treatment partially blunted PPHTg resulting in intermediate PPHTg. Group B with highest PPHTg showed highest subsequent IR, glucose intolerance (GI) and highest incidence of prediabetes at week 26 and diabetes at week 34 and 46 compared to other groups. Group D rats displayed lower IR, GI, low incidence of prediabetes and diabetes at these time points compared to Groups B and C. ROC analysis showed that triglyceride area under the curve of each time point significantly predicts the risk of diabetes. Present study provides the evidence that PPHTg predicts the development of IR, GI and T2DM in rat model of diet induced T2DM.

Pheohyphomycosis caused by Exophiala spinifera: a rare occurrence.

A 10-year-old immunocompetent boy presented with multiple, verrucous, disseminated pheohyphomycotic lesions caused by Exophiala spinifera. The patient was not responsive to combination antifungal therapy (itraconazole, terbinafine, fluconazole) and cryotherapy. As antifungal susceptibility is known to be variable for Exophiala spinifera, in vitro sensitivity testing is recommended before medical treatment. This article reviews, in brief, all cases documented so far in the English literature.

Prevalence of Helicobactor pylori in patients with perforated duodenal ulcer.

It is believed that Helicobacter pylori (H. Pylori) plays an important role in the causation of peptic ulcer. However, its role in duodenal ulcer perforation (DUP) has not been investigated extensively and the results are conflicting. The aim of this study was to determine the prevalence of H. pylori in patients with DUP patients as compared to normal healthy volunteers (NHV). Eighty-six consecutives patients with DUP and 30 NHV were included in the study. The NHV, drawn from the Surgery outpatient, were subjected to upper gastrointestinal (UGI) endoscopy and multiple gastric mucosal biopsies. Gastric mucosal biopsies among patients with DUP were obtained during laparotomy by passing a biopsy forcep through the perforation site. Biopsy specimens were put in urea broth for the rapid urease test (RUT), brucella broth (used as a transport medium) for culture and 10% formalin for histopathology. The results were analysed as the percentage of positive cases. The mean (+/-SD) age of patients with DUP (39.4+/-15.5 years) and of the NHV (36.0+/-13.9 years) were comparable (p= 0.290). Sixty-one (70.9%)patients with DUP had used NSAIDs prior to perforation. Only 7 patients with DUP (8.14%) had a past history of symptoms of duodenal ulcer and had been treated for it. A positive history of smoking, alcoholism and tobacco use was present in 68 (78.9%), 59 (68.6%) and 41(47.7%) patient with DUP, respectively. No culture was positive. Histology was positive for H. pylori in 29 patients with DUP and in 2 (6.7%)NHV. RUT was positive for H. pylori in 43(50%) patients with DUP and 5 NHV (16.7%). The present study documented a markedly higher association of H. Pylori infection with perforated duodenal ulcer.

Large nodal metastases from carcinoid tumor causing bowel obstruction.

A 39-year-old man presented with progressively increasing constipation and painful lumps in the abdomen. Exploration showed extensive nodal metastases but no primary lesion was seen. The masses were excised and sigmoid colostomy done. Histology revealed carcinoid tumor with small cell differentiation. A trial of chemotherapy gave no response. At follow up of 18 months he is leading a comfortable life with a colostomy and a billary stent in place (placed for obstructive jaundice due to porta node).

Histopathological assessment of the liver in cholelithiasis with cholecystitis.

Liver function and histology were studied in 62 patients undergoing elective cholecystectomy. Data from 50 of the cases was subsequently analyzed. Liver function was assessed by biochemical parameters and histological examination of intraoperatively obtained core and wedge liver biopsy. There were no complications associated with the procedure of liver biopsy. Seventy-eight percent of liver biopsies showed some form of abnormality, the commonest being mild portal tract infiltration. Eighteen percent of patients had severe histological abnormalities. Fourteen percent of bile samples were infected. No correlation was found among age, symptom duration, liver function tests, and histological appearance. Biliary infection was associated with a significant incidence of fatty change and inflammatory cell infiltration of parenchyma. We observed a high rate of abnormal liver histology of unknown clinical significance in patients of calculous cholecystitis. These changes are not reflected in commonly performed tests of liver function. Intraoperative liver biopsy is a safe and sensitive method to detect liver abnormalities.

Effects of Maitake mushroom fractions on blood pressure of Zucker fatty rats.

A link exists between insulin resistance and many chronic disorders of aging including advancing-age. A safer means to prevent or, at least, slow the erosion of insulin sensitivity would provide a novel approach to better health. We compared the ability of a specific extract labeled fraction SX, as well as whole Maitake powder, fraction ES and fraction D of Maitake to influence SBP and various pertinent biochemical parameters when given orally to Zucker Fatty rats, a model of insulin resistance and type 2 diabetes mellitus. A secondary gain was the ability to ascertain the effects of bitter melon, olive oil, and sesame oil alone and combined with fraction SX to influence SBP. We found that a water-soluble fraction obtained from Maitake mushroom (SX) lowers SBP and fasting blood glucose significantly over the three to six weeks of study. While whole Maitake fraction lowered SBP effectively, the effects on fasting blood sugar were not apparent under the conditions of study. In contrast to fraction SX and fraction D, developed primarily to enhance immunity and suppress tumor development and growth, has essentially no effect on SBP under the conditions examined. An ether soluble fraction designated ES lowers SBP significantly. Interestingly, olive oil, unlike sesame oil, also lowers SBP. Finally, bitter melon and a combination of SX plus bitter melon also lower SBP. We conclude that fraction SX of Maitake mushroom may be useful to treat insulin resistance alone or combined with other natural products such as bitter melon and niacin-bound chromium.