The paper provides a basic review of intestinal microflora and its importance in liver diseases. The intestinal microflora has many important functions, above all to maintain the microbial barrier against established ...The paper provides a basic review of intestinal microflora and its importance in liver diseases. The intestinal microflora has many important functions, above all to maintain the microbial barrier against established as well as potential pathogens. Furthermore, it influences the motility and perfusion of the intestinal wall, stimu- lates the intestinal immune system and therefore also the so-called common mucosal immune system, reducing bacterial translocation and producing vitamins. Immune homeostasis at mucosal level results from a controlled response to intestinal luminal antigens. In liver cirrhosis, there are many changes in its function, mostly an increase in bacterial overgrowth and translocation. In this review, probiotics and their indications in hepatology are generally discussed. According to recent knowledge, these preparations are indicated in clinical practice only for cases of hepatic encephalopathy. Probiotics are able to decrease the permeability of the intestinal wall, and decrease bacterial translocation and endotoxemia in animal models as well as in clinical studies, which is extremely important in the prevention of complications of liver cirrhosis and infection after liver transplantation. Probiotics could limit oxidative and inflammatory liver damage and, in some situations, improve the histological state, and thus non-alcoholic steatohepatitis could be considered as another possible indication.展开更多
Background:Diabetic ketoacidosis(DKA)is a common acute complication of diabetes mellitus requiring aggressive medical management.We attempted to study the incidence and various clinical and laboratory variables associ...Background:Diabetic ketoacidosis(DKA)is a common acute complication of diabetes mellitus requiring aggressive medical management.We attempted to study the incidence and various clinical and laboratory variables associated with acute gastrointestinal bleeding(AGIB)and acute upper AGIB(AUGIB)in patients with DKA.Methods:We conducted a retrospective chart review of all the patients admitted to our hospital with DKA between January 2010 and December 2015.We collected demographic,clinical,laboratory,endoscopy and hospitalization details using an electronicmedical-record database.Patients were divided into two groups based on the occurrence of gastrointestinal bleeding.Results:A total of 234 patients with DKA were admitted during this period,of which 27(11.5%)patients had documented AGIB.The majority of patients had hematemesis(n=22,9.4%)except two had rectal and three had occult bleeding.We did not notice any difference in age,gender and ethnicity distribution between the two groups.There was no difference in the serum levels of electrolytes,anion gap,pH and hemoglobin A1C between the two groups.However,patients with AGIB had significantly higher initial blood glucose levels(738 vs 613 mg/dL,p=0.014).There was also increased mortality(7.4%vs 4.8%)in patients with AGIB,but this did not reach statistical significance.Conclusion:We conclude that higher initial serum blood glucose was associated with increased incidence of AGIB in patients admitted with DKA.We also noted increased in-patient mortality in patients with DKA who had AGIB,even though statistically insignificant.More aggressive measures to correct blood glucose levels may result in decreased incidence of AGIB,thereby reducing mortality during hospitalization in patients with DKA.展开更多
文摘The paper provides a basic review of intestinal microflora and its importance in liver diseases. The intestinal microflora has many important functions, above all to maintain the microbial barrier against established as well as potential pathogens. Furthermore, it influences the motility and perfusion of the intestinal wall, stimu- lates the intestinal immune system and therefore also the so-called common mucosal immune system, reducing bacterial translocation and producing vitamins. Immune homeostasis at mucosal level results from a controlled response to intestinal luminal antigens. In liver cirrhosis, there are many changes in its function, mostly an increase in bacterial overgrowth and translocation. In this review, probiotics and their indications in hepatology are generally discussed. According to recent knowledge, these preparations are indicated in clinical practice only for cases of hepatic encephalopathy. Probiotics are able to decrease the permeability of the intestinal wall, and decrease bacterial translocation and endotoxemia in animal models as well as in clinical studies, which is extremely important in the prevention of complications of liver cirrhosis and infection after liver transplantation. Probiotics could limit oxidative and inflammatory liver damage and, in some situations, improve the histological state, and thus non-alcoholic steatohepatitis could be considered as another possible indication.
文摘Background:Diabetic ketoacidosis(DKA)is a common acute complication of diabetes mellitus requiring aggressive medical management.We attempted to study the incidence and various clinical and laboratory variables associated with acute gastrointestinal bleeding(AGIB)and acute upper AGIB(AUGIB)in patients with DKA.Methods:We conducted a retrospective chart review of all the patients admitted to our hospital with DKA between January 2010 and December 2015.We collected demographic,clinical,laboratory,endoscopy and hospitalization details using an electronicmedical-record database.Patients were divided into two groups based on the occurrence of gastrointestinal bleeding.Results:A total of 234 patients with DKA were admitted during this period,of which 27(11.5%)patients had documented AGIB.The majority of patients had hematemesis(n=22,9.4%)except two had rectal and three had occult bleeding.We did not notice any difference in age,gender and ethnicity distribution between the two groups.There was no difference in the serum levels of electrolytes,anion gap,pH and hemoglobin A1C between the two groups.However,patients with AGIB had significantly higher initial blood glucose levels(738 vs 613 mg/dL,p=0.014).There was also increased mortality(7.4%vs 4.8%)in patients with AGIB,but this did not reach statistical significance.Conclusion:We conclude that higher initial serum blood glucose was associated with increased incidence of AGIB in patients admitted with DKA.We also noted increased in-patient mortality in patients with DKA who had AGIB,even though statistically insignificant.More aggressive measures to correct blood glucose levels may result in decreased incidence of AGIB,thereby reducing mortality during hospitalization in patients with DKA.
