Metabolic aspects of adult patients with nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease(NAFLD) is a major cause of chronic liver disease and it encompasses a spectrum from simple steatosis to steatohepatitis, fibrosis, or cirrhosis. The mechanisms involved in the occurrence of NAFLD and its progression are probably due to a metabolic profile expressed within the context of a genetic predisposition and is associated with a higher energy intake. The metabolic syndrome(MS) is a cluster of metabolic alterations associated with an increased risk for the development of cardiovascular diseases and diabetes. NAFLD patients have more than one feature of the MS, and now they are considered the hepatic components of the MS. Several scientific advances in understanding the association between NAFLD and MS have identified insulin resistance(IR) as the key aspect in the pathophysiology of both diseases. In the multi parallel hits theory of NAFLD pathogenesis, IR was described to be central in the predisposition of hepatocytes to be susceptible to other multiple pathogenetic factors. The recent knowledge gained from these advances can be applied clinically in the prevention and management of NAFLD and its associated metabolic changes. The present review analyses the current literature and highlights the new evidence on the metabolic aspects in the adult patients with NAFLD.

Influence of weight management on the prognosis of steatohepatitis in chronic hepatitis B patients during antiviral treatment

Background:Although concomitant nonalcoholic steatohepatitis(NASH)is common in chronic hepatitis B(CHB),the impact of viral factors on NASH and the outcome of CHB patients concomitant with NASH remain unclear.We aimed to investigate the outcomes of NASH in CHB patients receiving antiviral treatment.Methods:In the post-hoc analysis of a multicenter trial,na?ve CHB patients receiving 72-week entecavir treatment were enrolled.We evaluated the biochemical,viral and histopathological responses of these patients.The histopathological features of NASH were also evaluated,using paired liver biopsies at baseline and week 72.Results:A total of 1000 CHB patients were finally enrolled for analysis,with 18.2%of whom fulfilling the criteria of NASH.A total of 727 patients completed entecavir antiviral treatment and received the second biopsy.Serum HBe Ag loss,HBe Ag seroconversion and HBV-DNA undetectable rates were similar between patients with or without NASH(P>0.05).Among patients with NASH,the hepatic steatosis,ballooning,lobular inflammation scores and fibrosis stages all improved during follow-up(all P<0.001),46%(63/136)achieved NASH resolution.Patients with baseline body mass index(BMI)≥23 kg/m2(Asian criteria)[odds ratio(OR):0.414;95%confidence interval(95%CI):0.190-0.899;P=0.012]and weight gain(OR:0.187;95%CI:0.050-0.693;P=0.026)were less likely to have NASH resolution.Among patients without NASH at baseline,22(3.7%)developed NASH.Baseline BMI≥23 kg/m2(OR:12.506;95%CI:2.813-55.606;P=0.001)and weight gain(OR:5.126;95%CI:1.674-15.694;P=0.005)were predictors of incident NASH.Conclusions:Lower BMI and weight reduction but not virologic factors determine NASH resolution in CHB.The value of weight management in CHB patients during antiviral treatment deserves further evaluation.

Childhood brucellosis:Review of 317 cases

Objective:To describe the main epidemiological,clinical,and laboratory features,treatment options and outcome in children with brucellosis.Methods:Retrospectively evaluated data were obtained from 317 pediatric patients with brucellosis that were treated at the University Clinic for Infectious Diseases and Febrile Conditions in Skopje,during the period from 1989 to 2011.The medical records and follow-up protocols were used for evaluation.Results:Childhood brucellosis composed 317(18.7%) of 1 691 patients with brucellosis.The patients were median 9 years old,ranging from 7 months to 14 years,and 201(63.4%) were males.Family history was present in 197(62.1%),and direct contact with animals occurred in 140(44.2%) of the children.The dominant manifestations were fever in 248(78.2%),joint pain in228(71.9%) and hepatomegaly in 216(68.1%).Organ affection was present in 206(65.0%)of the patients.One hundred and six(33.4%) of the patients were treated with combination composed of two.and 211(66.6%) with three antimicrobial agents.Relapses were registered in 21(6.6%).and therapeutic failures in 3(0.9%) of the children.Conclusions:In endemic regions childhood brucellosis represents a significant part of human cases.Wide spectrum of clinical manifestations,frequent affection of various organ systems and possibility of relapses show that brucellosis could be a serious disease in this age group.The presence of fever,joint pain,sweating,and affection of various systems in children from endemic regions should alert pediatricians for the possibility of brucellosis.

Safety in Surgery:Evaluation of Safety and Efficiency in Use of Aminoglycosides in Acute Appendicitis

Background: Aminoglycosides are used as empirical antibiotic treatment of intraabdominal infections which are caused by Gram negative bacteria and for which the treatment of choice is surgery. Aminoglycosides maintain good efficacy against these bacteria and reduce the need for prescribing fluoroquinolone, cephalosporin and carbapenem antibiotics which contribute to the development of resistant bacterial strains. In recent years, several clinical trials and international guidelines have advised against the use of aminoglycosides owing largely to doubts about their effectiveness and to the concern for their known nephrotoxicity and ototoxicity. Aim: In our study, we aimed to prove whether aminoglycosides are appropriate agents in the treatment of acute appendicitis. Methods: Retrospectively, patients with acute appendicitis we included in the trial. Demographic characteristics, comorbidities, clinical signs and symptoms, the type of antibiotic and surgical treatment were analyzed. The effect of independent variables on the occurrence of complications was calculated using Student’s T-test and Fisher’s precise test. The effect of aminoglycosides on the loss of kidney function was determined by means of a linear regression method. Results: 300 patients proved acute appendicitis were included in the study. Univariate statistical analysis showed that the risk factors for postoperative complications in treating acute appendicitis were: age over 76 years (p Conclusion: Aminoglycoside antibiotics are a safe and effective treatment of acute appendicitis;our not published data are positive of AGs use in acute cholecystitis and left colon diverticulitis which requires surgery. If used for a limited time period, they do not increase the risk for kidney injury and remain a stable low level of all over complications.

Diagnostic Evaluation of Ehrlichia canis Human Infections

Ehrlichiosis is an infection of the group of Vector Borne Diseases (VBD), caused by different echrlichia species (spp). Ehrlichiae are primarily recognized as causers of animal diseases, later as human diseases—Humane Monocytic (HME) and Humane Granulocytic (HGE) ehrlichiosis. The dogs, cats and rodents have natural reservoirs of ehrlichial agents. Ehcrlichiae are spread to human’s trough, the bites of infected ticks, sometimes resulting from contact with animals, possible to the transfusion. In period from 2008 to 2013, we analyzed 250 patients suspect of VBD. On examination, there were included clinical, laboratory and epidemiological methods. The confirmation of Ehrlichia canis was in serum of 64 patients, thanks to Indirect Immune fluorescent Assay (IIF). The other laboratory and serological methods (Elisa, IIF, and Western blood) are utilized for differential diagnosis, and detection of co-infective forms of diseases. Ehrlichia canis infection has been reported in humans as a cause of serious illnesses characterized by non specific symptoms: fever, headache, musculoskeletal pain, enlarged liver, neurological, hematological dysfunction. Co-infections with E. canis due to causers of different VBD have been documented in humans. In 53 cases, we detected co-infective participation of E. canis with Rickettsia conorii in 24 cases, Coxiella burneti in 6, and Borrelia burgdorferi in 23 cases. The preferred drug for both human ehrlichiosis is doxycycline, except children to 8 years, pregnant females. Ehrlichiosis is a difficult infectious disease to diagnose and prognose because of dominant non specific symptoms and co-infections.

Evaluating chromosomal segregation in a family where both spouses carry an autosomal translocation

Autosomal reciprocal translocations represent exchanges of chromatin fragments between non-homologous chromosomes.Translocations are facilitated by the creation of quadrivalent structures during the first meiotic division,which are characterized by the length of the translocated and centric segments,asymmetry,and the presence of terminal breakpoints,all of which may impact segregation mode.Here,we report a rare case of multiple reciprocal translocations within a single family.This includes the evaluation of the translocations in each of the spouses and an analysis of their chromosome segregation patterns as determined by the constellation of universal characteristics in each of their quadrivalents.The obtained results will be of interest to fundamental biology,as they will expand the understanding of the factors affecting chromosome segregation during meiosis.

A SARS-CoV-2 antibody retains potent neutralization against Omicron by targeting conserved RBM residues

The newly emerged Omicron(B.1.1.529)variant of SARS-CoV-2 is quickly overtaking the Delta variant and becoming the dominant strain around the world due to its enhanced transmissibility and high immune escape potential[1,2].Compared to the Wuhan strain,the Omicron variant carries 37 spike mutations,of which 15 are within the receptor-binding domain(RBD)(Fig.1A).A high mutation rate is associated with remarkable resistance to current vaccines and RBD-specific antibody therapeutics[2,3,4].

Efficacy and safety of the long-acting fusion inhibitor albuvirtide in antiretroviral-experienced adults with human immunodeficiency virus-1:interim analysis of the randomized,controlled,phase 3,non-inferiority TALENT study

Background:Albuvirtide is a once-weekly injectable human immunodeficiency virus(HIV)-1 fusion inhibitor.We present interim data for a phase 3 trial assessing the safety and efficacy of albuvirtide plus lopinavir-ritonavir in HIV-1-infected adults already treated with antiretroviral drugs.Methods:We carried out a 48-week,randomized,controlled,open-label non-inferiority trial at 12 sites in China.Adults on the World Health Organization(WHO)-recommended first-line treatment for>6 months with a plasma viral load>1000 copies/mL were enrolled and randomly assigned(1:1)to receive albuvirtide(once weekly)plus ritonavir-boosted lopinavir(ABT group)or the WHO-recommended second-line treatment(NRTI group).The primary endpoint was the proportion of patients with a plasma viral load below 50 copies/mL at 48 weeks.Non-inferiority was prespecified with a margin of 12%.Results:At the time of analysis,week 24 data were available for 83 and 92 patients,and week 48 data were available for 46 and 50 patients in the albuvirtide and NRTI groups,respectively.At 48 weeks,80.4%of patients in the ABT group and 66.0%of those in the NRTI group had HIV-1 RNA levels below 50 copies/mL,meeting the criteria for non-inferiority.For the per-protocol population,the superiority of albuvirtide over NRTI was demonstrated.The frequency of grade 3 to 4 adverse events was similar in the two groups;the most common adverse events were diarrhea,upper respiratory tract infections,and grade 3 to 4 increases in triglyceride concentration.Renal function was significantly more impaired at 12 weeks in the patients of the NRTI group who received tenofovir disoproxil fumarate than in those of the ABT group.Conclusions:The TALENT study is the first phase 3 trial of an injectable long-acting HIV drug.This interim analysis indicates that once-weekly albuvirtide in combination with ritonavir-boosted lopinavir is well tolerated and non-inferior to the WHO-recommended second-line regimen in patients with first-line treatment failure.Trial registration:ClinicalTrials.gov Identifier:NCT02369965;https://www.clinicaltrials.gov.Chinese Clinical Trial Registry No.ChiCTR-TRC-14004276;http://www.chictr.org.cn/enindex.aspx.

Leptospirosis distribution related to freshwater habitats in the Vojvodina region (Republic of Serbia)

The retrospective study (2002-2007) for human leptospirosis in Vojvodina was undertaken in order to describe the distribution of the disease in relation with some environmental factors. Regarding the presented results, the major detected number of leptospirosis cases concurs with stagnant waters, wetlands, fish pond areas and protected regions, which comprised the basis for mapping of the region in three risk zones: very high risk (incidence rate higher than 5.0), high risk (2.5-5.0) and medium risk of leptospirosis infection (1.0-2.5). During the investigated period, 97 cases were registered with an average of 13.85 cases per year: 2002, 32 cases; 2003, 7; 2004, 22; 2005, 16; 2006, 4 and 2007, 16. Out of these 97 cases only 5 were women. Serovars from 11 presumptive serogroups caused infection, with a predominance of Icterohaemorrhagiae and Bratislava, accounting for 72.72% of cases together. Icterohaemorrhagiae was the commonest infecting serogroup mostly connected with fish ponds. Case fatality ratio was 9.4%.

Consensus statement on human immunodeficiency virus pre-exposure prophylaxis in China

Introduction Although the global human immunodeficiency virus(HIV)epidemic has been effectively curbed,preventing and managing HIV infection in high-risk populations remains challenging.[1]In China,HIV is primarily transmitted through sexual contact.[1,2]Pre-exposure prophylaxis(PrEP)is a new and effective method for preventing HIV infection using antiretroviral drugs[3];data from multiple clinical trials worldwide have shown that using antiretroviral drugs for PrEP can limit HIV transmission.[4,5,6,7]The World Health Organization(WHO)issued guidelines in 2015 recommending PrEP in populations with an HIV incidence above 3/100 person-years(PY)and in individuals engaging in high-risk behaviors.[3]According to existing studies,the HIV incidence among key populations in China was 5.6/100 PY for men who have sex with men(MSM),[8]1.6/100 PY for intravenous drug users(IDUs),[9]and 1.4/100 PY for female sex workers.[10,11]As of July 2020,54 countries and regions have issued PrEP guidelines for adults to prevent HIV infection,and 36 of these have also published guidelines for children and adolescents.However,there are no PrEP guidelines or related consensus statement in China.As such,there is a strong need for standardized guidance on the implementation of PrEP pertaining to medical selection criteria,PrEP timing,drug safety,and consultation and testing programs.Here we present the consensus statement on the implementation of PrEP in China based on the opinions and suggestions of health policy-makers,scientists,clinical experts,community-based organizations of key populations,and the latest reports in PrEP researches.