EFFICACY OF INSULIN, HEPARIN AND FENOFIBRATE COMBINATION TREATMENT IN SEVERE HYPERTRIGLYCERIDEMIA: DOUBLE CENTER EXPERIENCE.

CONTEXT: Severe hypertriglyceridemia (SH), which calls for a triglyceride (TG) level above 1000 mg/dL, remains an important health issue. While some data exist to offer combination of heparin, insulin and fenofibrate as a reasonable treatment option, safety and benefits of this therapy have not been accurately weighted, largely due to the limited sample size of the relevant studies. AIM: Assess the efficacy and safety of the heparin, insulin and fenofibrate combination in the treatment of patients with SH. PATIENTS - METHODS: Patients aged ≥18 years with TG level above 1000 mg/dL and adequate organ function were included. Triglyceride levels were measured immediately before the treatment and on the 3rd and 6th days of the treatment. Treatment dosage, duration, response and side effects were assessed. Patients with hypertriglyceridemia presenting with acute pancreatitis were treated additionally with lipid apheresis. RESULTS: A total of 42 patients were included. Of these, 85.8% came to medical attention with some kind of secondary hypertriglyceridemia causes. The baseline median TG value of the cases was 2141.0 mg/ dL (1026-12250). There were 6 patients (14.3%) with acute pancreatitis at presentation. In patients without pancreatitis, with administration of insulin infusion, unfractionated heparin infusion and fenofibrate capsule, median TG values decreased to 921 mg/ dL (190-6400) on the 3rd day and to 437 mg/ dL (112-1950) on the 6th day of the treatment (p<0.0001, Friedman test). Potential toxicities related to insulin, heparin and fenofibrate combination treatment including hypoglycemia, hemorrhage, rise in creatine kinase levels, hepato - and nephrotoxicity were not observed. CONCLUSION: In this trial involving patients with SH, our data suggest that insulin, heparin and fenofibrate combination therapy was safe and effective.

The impact of bariatric surgery on obesity-related infertility.

OBJECTIVE: Our study aimed to investigate the effect of morbid obesity surgery on infertility using laparoscopic sleeve gastrectomy (LSG). PATIENTS AND METHODS: We performed a retrospective analysis from a prospectively collected database from May 2014 until December 2019. The mean age of the 23 morbidly obese women included in the study and followed-up for five years was 31.26 ± 5.06 years (minimum 24, maximum 43), mean duration of marriage was 9.3478 ± 4.76 years (minimum 4, maximum 23). Mean body mass index (BMI) values were 45.04 ± 3.43 (minimum 40, maximum 52) pre-LSG and 28.65 ± 3.14 (minimum 24, maximum 36) 12 months post-laparoscopic sleeve gastrectomy (LSG). RESULTS: Out of 23 infertile patients studied underwent LSG. Significant correlation was determined between the change in BMI, 12 months after LSG, compared to pre-LSG and having children after surgery (p=0.001). Conception occurred in 21 patients (91.3%) after surgery, but not in the remaining two (8.7%). CONCLUSIONS: LSG is an important surgical technique used in the treatment of obesity and in preventing obesity-related comorbidities. It can improve pregnancy and live birth rates by contributing to weight loss and hormonal regulation in obese infertile women.

Risk stratification in submassive pulmonary embolism via alveolar-arterial oxygen gradient.

AIM: This study investigated the utility of the alveolar-arterial (AaDO2) gradient in predicting the short-term prognosis of submassive pulmonary embolism (PE). MATERIAL AND METHODS: This study retrospectively enrolled 124 patients with acute submassive PE. During the first 24 h of admission, all patients had initial artery blood gas collected under room air. Cardiac troponin T (cTn-T) was measured and on spiral computed tomography pulmonary angiography (CTPA) and echocardiography both right ventricle diameter and left ventricle diameter was calculated (RV/LV ratio). Patients who did not have objectively confirmed submassive PE and who had curative anticoagulant treatment for more than 24 hours and had a life expectancy less than 3 months were excluded from the study. RESULTS: The best cut-off value for AaDO2 was 42.38 mmHg and using this, fourteen of 15 patients who died had AaO2 ≥ 42.38 and 71 of 109 patients who survived had a AaO2 lower than 42.38 with a sensitivity, specificity and negative predictive value (NPV) for overall deaths were 93.3%, 65.1% and 98.6% respectively. In addition, AaDO2 < 42.38 showed significant survival benefit for overall mortality rates. In this study, having high cTn-T and PaO2/ PaCO2 < 1.83 and pulmonary artery pressure > 47.5 were also an indicator of poor prognosis for patients with submasssive PE. CONCLUSION: The AaDO2 measurement is a highly useful and simple measurement for predicting short-term prognosis in patients with submassive PE. It may be used in risk stratification of patients with submassive PE. Aggressive thrombolytic treatment strategies may be considered for patients who have AaO2 < 42.38. Hippokratia 2014; 18 (4): 333-339.