TauroPharm ’s Post

Today I attended a brilliant educational session organised by Pancreatic Cancer UK in which Mary Phillips discussed PERT in the management of PEI and the current shortage of PERT in the UK. PERT is of great importance in the management of pancreatic exocrine insufficiency (PEI). However, data from the ROCHET audit showed that less than 50% of patients are being prescribed PERT with PERT more likely to be prescribed if the patient was seen by a dietitian, in a specialist centre or by a clinical nurse specialist. I am sharing with you the position statement which was issued yesterday. It is designed to meet the needs of clinicians' managing patients with pancreatic exocrine insufficiency (PEI). It provides advice for prescribers, and dietitians, which at the moment need to deviate from the standard practice to help with the difficulties or delays in accessing PERT currently. Some key points Advice for prescribers: #Creon 10,000 is only being delivered to hospitals and should be prioritised for children and those unable to swallow larger capsules #Nutrizym 22 is not available until after August 2024 and should be prioritised for those unable to tolerate Creon preparations Advice for dietitians: Remind about the importance of spreading PERT dose throughout the meal to aid better absorption Underline the importance of storing enzymes properly- under 25 degrees Use of peptide-based ONS rather than polymeric supplements- however, this does come with some cost implications Consider fat-free ONS sipped slowly without PERT if the patient is weight-stable. Consider a 10-20% reduction in dietary fat for patients who are symptomatic Consider reducing dietary fibre if large doses are consumed (>40g fibre per day) as high-fibre diets can reduce the efficacy of PERT. What are your thoughts on this issue? Are your patients experiencing difficulties with accessing PERT at the moment? #PERT #PEI #Pancreatingexocrineinsuffieciency #pancreaticenzymereplacementtherapy #dietitian #dietetics #pancreaticcancer #pancreaticcanceruk #cysticfibrosis

We need to reevaluate our diagnostic and treatment approaches to breath testing and SIBO In the realm of gastroenterology, the hypothesis connecting small intestinal bacterial overgrowth (SIBO) to irritable bowel syndrome (IBS) has been a significant driver of research and clinical focus for over two decades. Initially, it was proposed that an overgrowth of bacteria in the small intestine might be a causative factor in IBS, a condition affecting millions worldwide. However, despite extensive research, this hypothesis remains unproven. Current recommendations from both European (ESNM) and American (ANMS) societies of neurogastroenterology and motility urge a critical reassessment of this approach due to several unintended consequences. Chief among these is the widespread use of breath tests for diagnosing SIBO, which are often unreliable and lack validation. This has led to the injudicious use of antibiotics, raising concerns about antibiotic resistance and patient safety. Recent studies into the gut microbiome and its interactions with the host have underscored the complexity of microbe-host interactions in the gastrointestinal tract. These studies suggest that while microbial communities play a significant role in gut health, more mechanistic research is needed to fully understand their impact on IBS and related disorders. Given the current evidence and expert recommendations, it is time to shift away from the SIBO hypothesis and the reliance on breath testing for diagnosis. Future research should focus on detailed mechanistic studies of gut microbiota and their interactions with the host to develop more accurate diagnostic tools and effective treatments for IBS and related disorders. This pivot is crucial to advancing our understanding and improving patient outcomes. Link to „Critical appraisal of the SIBO hypothesis and breath testing…” paper by Purna Kashyap, Paul Moayyedi, Eamonn Quigley, Magnus Simren and Stephen Vanner: https://lnkd.in/ecvMJBvA Thoughts and experiences on this topic in the comments below are welcome. #Gastroenterology #IBS #SIBO #GutHealth #Microbiome #MedicalResearch #PatientSafety #AntibioticStewardship #DGBI

Liver function tests (LFTs) Liver function tests (LFTs), also known as liver panel or hepatic function tests, are a group of blood tests used to assess the overall health and function of the liver. These tests are typically ordered by healthcare providers to evaluate liver disease, monitor liver function, or assess the effects of medications or treatments on the liver. The most common liver function tests include: 1. Alanine transaminase (ALT): ALT is an enzyme found primarily in the liver. Elevated levels of ALT in the blood may indicate liver damage or injury, such as hepatitis or cirrhosis. 2. Aspartate transaminase (AST): AST is another enzyme found in the liver, as well as in other organs such as the heart, muscles, and kidneys. Elevated AST levels can be a sign of liver disease, but they are less specific to the liver than ALT. 3. Alkaline phosphatase (ALP): ALP is an enzyme present in various tissues, including the liver, bile ducts, bones, and intestines. Elevated ALP levels can be seen in conditions such as liver disease, bile duct obstruction, or bone disorders. 4. Gamma-glutamyl transferase (GGT): GGT is an enzyme found in the liver and other organs. Elevated GGT levels may indicate liver disease or alcohol abuse. 5. Total bilirubin: Bilirubin is a yellow pigment produced when red blood cells break down. Elevated levels of bilirubin can be a sign of liver disease, gallbladder problems, or excessive breakdown of red blood cells. 6. Albumin: Albumin is a protein produced by the liver. Low levels of albumin may indicate liver dysfunction or malnutrition. 7. Prothrombin time (PT): PT measures the time it takes for blood to clot. Prolonged PT can be a sign of liver disease, as the liver produces clotting factors. It's important to note that liver function tests provide general information about liver health but are not diagnostic of specific liver conditions. Abnormal test results may require further evaluation, including additional tests and medical assessment by a healthcare professional. If you have any concerns about your liver function or the interpretation of your liver function test results, it's best to consult with a medical professional who can provide personalized advice and guidance. #CAP #CBAHI #Healthcare #Laboratory #Medical #medicaldevices #innovation #diagnosis #health #clinicaldiagnostics #medlabmiddleeast #Device #arabhealth #Instrument #Specialist #Technician #Patient #Quality #Safety #Hematology #CBC #Biochemistry #spectrophotometer #Bioassay #Chemiluminescence #immunoassay #type #ELISA #Cobas #Vitros #Abbott #Siemens #IVD #Beckman #Roche #Sysmex #Danaher #Human #Diagnostic #Mindray #Snibe #Maglumi #Agappe #OpenToWork #job #work #HR #jobopportunity #opportunity

𝐁𝐞𝐧𝐞𝐟𝐢𝐭 𝐨𝐟 𝐀𝐥𝐛𝐮𝐦𝐢𝐧 𝐈𝐧𝐟𝐮𝐬𝐢𝐨𝐧 𝐢𝐧 𝐚𝐧 𝐄𝐥𝐝𝐞𝐫𝐥𝐲 𝐂𝐢𝐫𝐫𝐡𝐨𝐭𝐢𝐜 𝐏𝐚𝐭𝐢𝐞𝐧𝐭 𝐨𝐧 𝐃𝐎𝐀𝐂 Author: AIT OUALI LAMIA Hypoalbuminemia is frequently observed in decompensated cirrhotic patients, exacerbated by nutritional status, renal insufficiency common that are in elderly patient leading to infectious, hemodynamic, hydroelectrolytic complications and increased bioavailability of certain drugs like DOACs. Albumin perfusion, alone or in combination with other medications, has been suggested for treating various cirrhosis complications [1]. We invite you to look into the case of our patient cirrhotic Child- Pugh A on DOAC that was infused with albumin. 𝐂𝐚𝐬𝐞 𝐏𝐫𝐞𝐬𝐞𝐧𝐭𝐚𝐭𝐢𝐨𝐧 The patient is an 89-year-old female with a history of type II diabetes on diet control, left partial nephrectomy with moderate chronic renal insufficiency, metabolic cirrhosis (NASH) CHILD-PUGH A on DOAC for atrial fibrillation. Admitted to geriatric FRC (Follow-up and Rehabilitation Care) unit for rehabilitation following Oedema-as- cites decompensation due to urinary sepsis. Clinical presentation on arrival and during hospital stay: 𝐂𝐚𝐫𝐝𝐢𝐚𝐜 𝐚𝐬𝐬𝐞𝐬𝐬𝐦𝐞𝐧𝐭: Atrial fibrillation arrhythmia with CHADS VASC score of 5. Dabigatran anticoagulation switched to Eliquis due to worsening renal function with creatinine clearance at 21.5 ml/min. Calcified aortic stenosis (TAVI). Global cardiac decompensation in the context of SARS-CoV-2 infection. 𝐏𝐮𝐥𝐦𝐨𝐧𝐚𝐫𝐲 𝐚𝐬𝐬𝐞𝐬𝐬𝐦𝐞𝐧𝐭: Non-oxygen-requiring SARSCoV2 pneumonia with signs of pulmonary arterial hypertension (PAH). 𝐈𝐧𝐟𝐞𝐜𝐭𝐢𝐨𝐮𝐬: Severe sepsis originating from urinary source with ESBL Klebsiel- la pneumoniae Hepatic side : Edematoascitic decompensation cirrhosis, Elastometry at 46.5 kPA. Renal side : Hepatorenal syndrome. To read full article: https://lnkd.in/gYFXKFss Thanks for Reading, Herald Scholarly Open Access #casereport #gastroenterology #hepatology This post is public so feel free to share it.

#Blood transfusions are crucial in managing various medical conditions and are integral to modern medical practice. However, concerns have arisen regarding potential complications associated with transfusions, particularly their impact on hemostasis and thrombotic events. Deep vein thrombosis (DVT) and arterial thromboembolism (ATE), serious complications linked to altered hemostasis, present challenges to patient care. #OUR study is a retrospective, population-based, cohort study that investigates the association between blood transfusions, venous thromboembolism (VTE), ATE, and subsequent mortality in patients undergoing recurrent blood transfusions. 1000 patients who received red blood cells (RBCs), platelets, fresh frozen plasma (FFP), and cryoprecipitate between 2015 and 2022 were analyzed. Post-transfusion occurrences of VTE and ATE were assessed using the chi-square test and multivariate logistic regression to identify independent risk factors. Multivariable regression analysis revealed a significant association between platelet transfusion and increased odds of development of ATE. However, no correlation was found between blood transfusions and the development of DVT. Notably, patients aged 55–69 years in the blood transfusion cohort exhibited a higher risk of DVT (p < 0.05), particularly those without chronic or cardiovascular diseases. Haematological diseases increased the demand for platelets and FFP, while patients without chronic diseases favoured platelet transfusions. Furthermore, patients with haematological or malignancy diseases, free of chronic diseases, had a higher likelihood of mortality within the blood transfusion cohort. Although the cause-and-effect relationship remains undetermined, these findings underscore the significant association between platelet transfusions and the risk of ATE, emphasising the importance of vigilant blood transfusion management practices. #The study’s outcomes would facilitate a clear understanding of the potential risks associated with blood transfusion, thereby aiding healthcare providers in making informed decisions, particularly in emergency medicine #SIGNAVITA #Thrombosis #DEATH #BloodTransfusion Farjah Algahtani (MD,MPH) #KSU #center

Exogenous lactate elevates cardiac output by 47% - in pigs Lactate and ketone (BHB) are important twin metabolites that raises systemically after exercise and fasting. Both metabolites are energy sources and function as signal molecules for a cascade of bodily preservation and restitution (hormonal) reactions. Therefore, the use of exogenous lactate and BHB is now extensively studied as supportive tools for many acute and chronic diseases. As per example, clinical research has shown that exogenous BHB entails a marked positive effect on cardiac output (CO) why BHB might be important in cases of a compromised heart. However, until now, little evidence was available on lactate in this capacity. But in a convincing controlled animal trial in pigs, exogenous lactate increased CO by a stunning 47%, or from 4.3 to 6.2 L/min. The authors note “Lactate infusion increased cardiac output by increasing heart rate and lowering afterload,” and “Lactate holds potential as a treatment in situations with lowered CO and should be investigated in future clinical studies”. Check out this reference for more: https://lnkd.in/d8Vgw4VX We believe lactate-ketone esters that provides both lactate and BHB would be the logical choice to help ameliorate reduced heart efficiency. See https://mmimetika.com/ for more.

Our secondary analysis of an RCT looking at coronary artery calcification #CAC progression in patients on statin therapy randomized to EPA+DHA or statin is out in The American Journal of Cardiology. Our findings show that patients with diabetes on EPA+DHA had a greater increase in CAC compared to control. These findings may suggest a plaque stabilizing effect of therapy. 💊 🫀 https://lnkd.in/gxi8236i

It's terrifying and concerning. High levels of triglycerides in the blood raise the risk of heart disease and stroke. When we have higher circulating triglycerides, it is NOT good. Researchers at Mayo Clinic showed that higher triglycerides could lead to hypertriglyceridemic acute pancreatitis (1) (1) https://mayocl.in/48PkVOd ADDReB Lab of Stanford Cardiovascular Institute collaborated with Chun's lab at Yale on this critical issue of what causes fatty acid deposition to the organs #2. Chun's lab showed that increasing apelin signaling prevents organ fatty acid deposits. Apelin signaling decreased endothelial FABP4 and prevented excess tissue FA accumulation. The bottom line is that EXERCISE or improving apelin signaling is curative to many complications. #2 https://lnkd.in/gT3aFDaA Euan Ashley, Joseph C. Wu, Michael Snyder, Hyung Chun

https://lnkd.in/gukWq9Em Article title: Resveratrol and Spirulina: Nutraceuticals that Potentially Improving Cardiovascular Disease Author(s): Yifan Wang; Maria Fides Ocampo; Bianca Rodriguez; Jiwang Chen Journal: Journal of Cardiovascular Medicine and Cardiology Journal ISSN: 2455-2976 Abstract: Resveratrol (3,5,4’-trihydroxy-trans-stilbene) is an extensively studied nutraceutical with several proposed health benefits, including cardio protection, antimetabolic syndrome, and antiatherogenic effects. It was brought to popularity through the proposed “French Paradox” and the consumption of red wine. It has been shown to down regulate the activation of numerous inflammatory and oxidative stress markers with therapeutic potentials. Spirulina (Arthrospira platensis), on the other hand, is a highly nutritional nutraceutical that has not been sufficiently studied. However, several in vitro and animal studies point to its hypolipidemic and antihypertensive properties, which are similar to resveratrol. Although resveratrol and Spirulina both constitutes functional foods with potential therapeutic effects on several cardiovascular diseases, there are few compelling clinical evidence to support their applications in human patients. This warrant further evaluation in clinical trials. This article reviews and evaluates the beneficial effects of the two different nutraceuticals in order to demonstrate their potential in clinical application in patients with cardiovascular diseases. #Resveratrol #Spirulina #CardiovascularDiseases #Dietary #Reviews #CoronaryArteryDiseases #ValvularHeartDisease #Electrophysiology #CardiacElectrophysiology #Echocardiography #InterventionalCardiology #ClinicalCardiology #NuclearCardiology #AcuteCoronarySyndromes #ArrhythmiaEP #CVImaging #CVDPrevention #CardiacArrhythmias #Peertechz #PeertechzPublications #OpenAccess #ScientificJournals #PeerReviewedJournals #OpenAccessPublishers #CardiacPhysiology #CardiacRegeneration #CardiacRehabilitation #Cardiomyopathies #CardiovascularDrugs #CardiovascularTherapy #CardiovascularAnatomy #CongenitalHeartDefects 

https://lnkd.in/g8bCbtrd Article title: Proliferative Glomerulonephritis with Monoclonal Immunoglobulin Deposition: Report of Two Cases and Review of Literature Author(s): Renu Mariam Thomas* Journal: Archives of Renal Diseases and Management Journal ISSN: 2455-5495 Abstract: Here we report two cases of proliferative glomerulonephritis with monoclonal IgG deposits, a form of renal involvement by monoclonal gammopathy that mimics immune complex glomerulonephritis. Case 1 presented with incidental proteinuria and a renal biopsy showed mesangioproliferative glomerulonephritis with monoclonal IgG kappa deposits on immunofluorescence examination. He remains stable after one year follow up. #Glomerulonephritis #Monoclonal #RenalTubularAcidosis #AcquiredCysticKidneyDisease #Albuminuria #AlbuminuriaAndCKD #AlportSyndrome #AmyloidosisAndKidneyDisease #AnalgesicNephropathy #AnatomyOfTheKidneys #AnatomyOfTheUrinarySystem #AnemiaInChronicKidneyDisease #AnemiaOfInflammationAndChronicDisease #AngiotensinReceptorBlockers #ArteriovenousFistula #ArtificialKidney #Bedwetting #BiopsyOfTheKidneys #BiopsyOfTheProstate #BladderAndTheUrinaryTract #BladderControl #BloodInTheUrine #BloodPressure #BloodPressureControlAndCKD #BloodUreaNitrogen #BoneDiseaseOfKidneyFailure #CardiovascularDiseaseAndCKD #ChildhoodKidneyStones #ChildhoodNephroticSyndrome #ChildrenAndKidneyDisease #ChildsBedwetting #ChronicKidneyDiseaseAndDiet #Peertechz #PeertechzPublications #OpenAccess #ScientificJournals #PeerReviewedJournals #OpenAccessPublishers #ChronicKidneyDiseaseAndKidneyFailure #ChronicKidneyDiseaseAndNutrition #ComplicationsInKidneyDisease #ComplicationsOfKidneyFailure #Cystinuria #Cystitis #Cystocele #DiabeticKidneyDisease #DiagnosticTestsForKidneyDiseases #Dialysis #EctopicKidney #ErectileDysfunction #EndStageRenalDisease #EnuresisInChildren #EstimatedGlomerularFiltrationRate #GlomerularDiseases #Glomerulonephritis #Glomerulosclerosis #GoodpastureSyndrome #Hemodialysis #Hematuria #ImagingOfTheUrinaryTract #ImmunizationsAndCKD #InterstitialCystitis #KidneyBiopsy #KidneyCysts #KidneyDysplasia #KidneyFunction #KidneyInfection #KidneyTransplantation #MedullarySpongeKidney #MembranousNephropathy #NephroticSyndrome #NocturnalEnuresis #NutritionAndCKD #NutritionAndKidneyDiseases #PainfulBladderSyndrome #PediatricKidneyDisease #PerinealInjury #PeritonealDialysis #PeyroniesDisease #PolycysticKidneyDisease #ProstateProblems #Proteinuria #Pyelonephritis #RenalTransplantation #SimpleKidneyCysts #SolitaryKidney #SpongeKidney #Stoma #StressIncontinence #Ureteroscopy #UrinaryDiversion #UrinaryRetention