Fatty Meal Research Articles

In Silico Food-Drug Interaction: A Case Study of Eluxadoline and Fatty Meal.

Food-drug interaction is an infrequently considered aspect in clinical practice. Usually, drugs are taken together with meals and what follows may adversely affect pharmacokinetic and pharmacodynamic properties, and hence, the therapeutic effects. In this study, a computational protocol was proposed to explain the different assimilations of two µ-receptors agonists, eluxadoline and loperamide, with a peculiar pharmacokinetic profile. Compared to loperamide, eluxadoline is absorbed less after the intake of a fatty meal, and the LogP values do not explain this event. Firstly, keeping in mind the different pH in the intestinal tract, the protonation states of both compounds were calculated. Then, all structures were subjected to a conformational search by using MonteCarlo and Molecular Dynamics methods, with solvation terms mimicking the water and weak polar solvent (octanol). Both computational results showed that eluxadoline has less conformational freedom in octanol, unlike loperamide, which exhibits constant behavior in both solvents. Therefore, we hypothesize that fatty meal causes the “closure” of the eluxadoline molecule to prevent the exposure of the polar groups and their interaction with water, necessary for the drug absorption. Based on our results, this work could be a reasonable “case study”, useful for future investigation of the drug pharmacokinetic profile.

Optimal hepatobiliary scintigraphy for gallbladder dyskinesia

BackgroundThe accuracy of hepatobiliary scintigraphy to assess gallbladder function remains controversial. National supply shortages of pharmaceutical-grade cholecystokinin led to the use of an oral fatty meal to stimulate gallbladder contraction during hepatobiliary scintigraphy. The goal of this study was to compare the predictive indices of cholecystokinin and fatty meal ingestion for stimulation of gallbladder contraction. MethodsPatients evaluated with hepatobiliary iminodiacetic acid scan from 2014 to 2017 were reviewed and grouped based on testing stimulant (fatty meal versus cholecystokinin). Patients who later underwent cholecystectomy were selected for analysis. Hepatobiliary iminodiacetic acid results were correlated with surgical pathology and postoperative resolution of symptoms. Two-way statistical analysis was performed. ResultsA total of 359 patients underwent hepatobiliary iminodiacetic acid scan followed by cholecystectomy for biliary dyskinesia. Patients who received fatty meal stimulant (n = 86) were compared to those that received cholecystokinin (n = 273). Mean gallbladder ejection fraction during hepatobiliary iminodiacetic acid was 38% and 44% for the cholecystokinin and fatty meal groups, respectively, P = .073. Predictive metrics were not statistically different between groups with regard to pathology, symptomatic improvement, or accuracy. Symptomatic resolution (cholecystokinin–hepatobiliary iminodiacetic acid 78%, fatty meal–hepatobiliary iminodiacetic acid 68%; P = 0.058) and specificity (cholecystokinin–hepatobiliary iminodiacetic acid 26%, fatty meal–hepatobiliary iminodiacetic acid 44%, P = 0.417) were comparable in both testing groups. ConclusionStimulation of gallbladder contraction with a fatty meal during hepatobiliary iminodiacetic acid testing is a more affordable and reliable alternative to cholecystokinin for patients undergoing evaluation for gallbladder dysmotility.

Evaluation of circulating miR-122, miR-30c and miR-33a levels and their association with lipids, lipoproteins in postprandial lipemia

AimsPostprandial lipemia is characterized by an increase in triglyceride-rich lipoproteins after fatty meals. MicroRNAs (miRs) play important roles in lipid and lipoprotein metabolism. The aim of this study was to determine relationship between levels of plasma miR expression and lipoprotein metabolism-related proteins in subjects with normal (NPR) and high postprandial response (HPR) in postprandial period. Materials and methodsThe oral fat tolerance test was applied to 22 individuals with NPR and 22 with HPR. Key findingsIncreased expressions of miR-122 and miR-33a and miR-122/30c ratio and decreased miR-30c expression were observed in fasting and postprandial period of HPR compared with NPR. ROC curve analysis showed that miR-122/30c ratio is a good biomarker for postprandial lipemia (AUC: 0.97, p < 0.001). Levels of TG, MTTP, and Apo B-48 and chylomicron (CM) particle size were significantly higher in HPR than in NPR (p < 0.05). The miR-122/30c ratio at 2 h was positively correlated with CM particle size, and with TG, MTTP and Apo B-48 levels at 4th hour. miR-33a expression decreased in HPR and was negatively correlated with ABCA1 and Apo A-1 levels at 4th hour of the postprandial period in both groups. SignificanceIncreased miR-122 and decreased miR-30c expression levels in HPR may play critical roles in elevated or prolonged postprandial lipemia. The miR122/30c ratio exhibited good association with MTTP, Apo B-48 and TG levels, and with CM particle size, and may be a reliable marker for evaluating postprandial lipemia. miR-33a may also play a key role in decreased HDL-C in postprandial lipemia.

A novel n-3 glyceride mixture enhances enrichment of EPA and DHA after single dosing in healthy older adults: results from a double-blind crossover trial.

A glyceride mixture of monoglyceride, diglyceride and TAG increases solubilisation and enhances emulsification of n-3 fatty acid (FA)-containing lipids in the stomach. This allows for better access of digestive enzymes, pivotal for the release of bioactive n-3 FA. The objective was to compare the effect of a glyceride formulation and an ethyl ester formulation of EPA + DHA on concentrations of EPA and DHA in plasma following single dosing. We conducted a double-blind crossover trial in which twenty healthy adults aged 50-70 years consumed a single dose (2·8 g EPA + DHA) of each EPA + DHA formulation without a meal in random order separated by a 2-week washout period. EPA and DHA were measured in plasma total lipid over the following 12 h. EPA and DHA in plasma total lipid increased over 12 h with both formulations. A 10-fold greater Δ concentration of EPA, 3-fold greater Δ concentration of DHA and 5-fold greater Δ concentration of EPA + DHA were seen with the glyceride-EPA + DHA. The time at which the maximal concentrations of n-3 FA occurred was 4 h earlier for EPA, 1 h earlier for DHA and 2 h earlier for EPA + DHA when consuming glyceride-EPA + DHA. A mixture of monoglyceride, diglyceride and TAG results in greater and faster incorporation of EPA and DHA into blood plasma lipid in the absence of a fatty meal. This may provide benefit to individuals on a low-fat diet or with digestive impairments and could result in greater efficacy in clinical trials using n-3 FA.

A pilot study on the effect of fat loading on the gastrointestinal tract of healthy dogs.

To assess the effect of a high fat meal (fat loading) on gastrointestinal motility and the appearance of intestinal villi using video capsule endoscopy and ultrasound. Four healthy staff-owned dogs were included in a prospective blinded crossover study. Dogs had initial baseline video capsule endoscopy to measure gastrointestinal transit times and allow for visual assessment of intestinal mucosa. Abdominal ultrasound was also performed to obtain intestinal wall measurements and assess for the presence of mucosal hyperechoic speckling. All dogs had diagnostics repeated twice between one and two hours after ingestion of either corn oil or dairy cream for a total of four control and 16 fat loaded studies. Dogs in the corn oil group had greater mean gastric emptying times (740.3 ± 187.6 minutes vs. 237.9 ± 155 minutes) and total transit times (54.50 ± 22.2 hours vs. 23.25 ± 6.1 hours) than controls. Feeding of a fatty meal resulted in substantial retention of the capsules (10 of 16) within the stomach. While intestinal wall thickness of fat loaded dogs did not differ from control dogs, mucosal hyperechoic speckling scores of the duodenum of dairy cream dogs were greater when compared to control dogs (1.625 ± 0.518 vs. 0.500 ± 0.577). Data from this pilot study provides further evidence that feeding of a small high fat meal results in ultrasonographic as well as visual changes to the intestinal mucosa of healthy dogs. This data suggests that previous recommendations to feed fatty meals to dogs with lymphangiectasia might not allow differentiation with healthy individuals. In addition, due to the marked effect on gastric emptying time, video capsule endoscopy should be avoided in dogs fed a high fat meal.

S3496 Endoscopic Retrospective Cholangiopancreatography (ERCP) in a Patient With Situs Inversus

INTRODUCTION: ERCP is an important therapeutic tool in the management of many pancreatico-biliary diseases. Situs inversus viscerum (SIV) is a rare congenital condition characterized by complete transposition of all viscera. We describe our successful ERCP for choledocholithiasis in a patient with SIV. CASE DESCRIPTION/METHODS: A 70 year old female with SIV presented with one day history of severe non radiating epigastric abdominal pain. She had prior similar episodes with fatty meals that resolved without intervention. Initial labs showed total bilirubin of 3.8, ALP 125, AST 1448 and ALT of 1420. A CT scan of the abdomen showed prominent common bile duct. Under general anesthesia, the patient was placed in a prone position. The endoscopist performed the procedure on the left side of the patient. The duodenoscope was passed through the esophagus into the stomach based on landmarks, such as the Z-line and the transition to gastric mucosa. Then, we followed the direction of the gastric folds, allowing the duodenoscope to pass along the surface of the greater curvature. The duodenoscope was advanced to the second part of the duodenum. The major papilla was seen at 6 o clock. The duodenoscope was then rotated counterclockwise 180 degrees. The bile duct was successfully cannulated and ERCP was completed. DISCUSSION: ERCP in situs inversus patient can be challenging. Following anatomic landmarks, appreciation of the congenital abnormality, use of fluoroscopy and vigilant endoscopic maneuvers can aid successful ERCP.Figure 1.: Showing cholangiogram in situs inversus.

Image Quality and Interpretation of [18F]-FES-PET: Is There any Effect of Food Intake?

Background: High physiological 16α-[18F]-fluoro-17β-estradiol ([18F]-FES) uptake in the abdomen is a limitation of this positron emission tomography (PET) tracer. Therefore, we investigated the effect of food intake prior to PET acquisition on abdominal background activity in [18F]-FES-PET scans. Methods: Breast cancer patients referred for [18F]-FES-PET were included. Three groups were designed: (1) patients who consumed a chocolate bar (fatty meal) between tracer injection and imaging (n = 20), (2) patients who fasted before imaging (n = 20), and (3) patients without diet restrictions (control group, n = 20). We compared the physiological [18F]-FES uptake, expressed as mean standardized uptake value (SUVmean), in the abdomen between groups. Results: A significant difference in [18F]-FES uptake in the gall bladder and stomach lumen was observed between groups, with the lowest values for the chocolate group and highest for the fasting group (p = 0.015 and p = 0.011, respectively). Post hoc analysis showed significant differences in the SUVmean of these organs between the chocolate and fasting groups, but not between the chocolate and control groups. Conclusion: This exploratory study showed that, compared to fasting, eating chocolate decreases physiological gall bladder and stomach [18F]-FES uptake; further reduction through a normal diet was not seen. A prospective study is warranted to confirm this finding.

Sonographically determined clues to the symptomatic or silent cholelithiasis.

To determine an association between sonographically determined contractility with the symptomatic or silent nature of gallstone. Designing: Comparative, cross-sectional study. Radiology Department, Dow University of Health Sciences (DUHS) and Civil Hospital, Karachi (CHK), from April 2004 to March 2005. Adult gallstone patients without (group I) and with biliary symptoms (group II) were compared with age and gender-matched controls. Demographic data, body mass index, risk factors, size, number and mobility of gallstone, gallbladder wall thickness (GBWT), volume and Ejection Fraction (EF) were determined on ultrasound before and after a standardized fatty meal (BFM and AFM). Demographic data, risk factors and gallstone characteristics were analyzed by Pearson Chi-square test and the gallbladder characteristics were analyzed by One-way ANOVA and Post Hoc tests by multiple comparisons on SPSS 11 with significance p=0.05. The gallbladder contractility as measured by changes in wall thickness and volume changes BFM and AFM, and ejection fraction was similar in controls and asymptomatic cholelithiasis groups and significantly reduced in symptomatic patients (p < .001). Multiparity (p=0.002), female gender (p=0.018), age less than 50 years (0.05), impacted calculi (p=0.001), multiple calculi (< .001) and calculi 5mm (p < 0.001) were associated with pain. A sluggishly emptying gallbladder was more significantly associated with symptomatic cholelithiasis compared to controls and asymptomatic cholelithiasis state in this series. Consideration of age, gender, impaction of calculi, number and size of calculi is important in causing symptom state and management options.

Deciphering the reasons for milky-white blood donor plasma.

Donors who eat a fatty meal before donating blood are known to have an increased level of plasma triglyceride concentrations for several hours. This may contribute to "milky-white" appearance of their plasma samples. We herein report the case of a blood donor who gave a history of the intake of a fatty meal, on the night prior to donation. This was affirmed by his serum lipid concentration done on the following day and on repeating the same subsequently after two weeks of donation respectively.

ApoB48 as an Efficient Regulator of Intestinal Lipid Transport.

Fatty meals induce intestinal secretion of chylomicrons (CMs) containing apolipoprotein (Apo) B48. These CMs travel via the lymphatic system before entering the circulation. ApoB48 is produced after post-transcriptional RNA modification by Apobec-1 editing enzyme, exclusively in the small intestine of humans and most other mammals. In contrast, in the liver where Apobec-1 editing enzyme is not expressed (except in rats and mice), the unedited transcript encodes a larger protein, ApoB100, which is used in the formation of very low-density lipoproteins (VLDL) to transport liver-synthesized fat to peripheral tissues. Apobec-1 knockout (KO) mice lack the ability to perform ApoB RNA editing, and thus, express ApoB100 in the intestine. These mice, maintained on either a chow diet or high fat diet, have body weight gain and food intake comparable to their wildtype (WT) counterparts on the respective diet; however, they secrete larger triglyceride (TG)-rich lipoprotein particles and at a slower rate than the WT mice. Using a lymph fistula model, we demonstrated that Apobec-1 KO mice also produced fewer CMs and exhibited reduced lymphatic transport of TG in response to duodenal infusion of TG at a moderate dose; in contrast, the Apobec-1 KO and WT mice had similar lymphatic transport of TG when they received a high dose of TG. Thus, the smaller, energy-saving ApoB48 appears to play a superior role in comparison with ApoB100 in the control of intestinal lipid transport in response to dietary lipid intake, at least at low to moderate lipid levels.

Evaluation of Gall Bladder Volume in Type 2 Diabetes Mellitus Patients Using Real Time Ultrasonography

Background: Diabetes mellitus is a group of metabolic diseases characterized by chronic hyperglycemia resulting from defects in insulin secretion, insulin action, or both. Autonomic neuropathy manifests as esophageal dysfunction, nocturnal diarrhea, gall bladder dysfunction, sphincter disturbances, atonic bladder and orthostatic hypotension. The present study aimed to evaluate and compare the gall bladder volume in fasting and post prandial state by real time ultrasound in Type 2 Diabetes Mellitus (T2DM) patients and healthy controls. Subjects and Methods: In this cross sectional study, 90 subjects were included. Among them, 45 were type 2 diabetes mellitus patients included as cases and 45 age and sex matched healthy controls, who attended the Department of Medicine and Radio-diagnosis, Akash Institute of Medical Sciences &amp; Research Centre, Devanahalli, Bengaluru, Karnaaka. All the study subjects were underwent detailed general and systemic examinations. Under aseptic conditions, 3ml fasting blood samples were collected and used for the estimation of fasting blood sugar, post prandial blood sugar. Gall bladder volume evaluation in fasting and 45 minutes post prandial (standardized fatty meal) state were done in T2DM patients and controls using real time ultrasound (GE Voluson P8 Mechine). Results: In the present study, BMI (24.78 2.31 kg/m2), FBS (160.98 27.99 mg/dl), PPBS (244.31 38.91 mg/dl), Fasting gall bladder volume (33.33 6.42 cm3), post fatty meal gall bladder volume (15.21 6.39 cm3), ejection fraction (49.34 17.29 cm3) were significantly increased in type 2 diabetes mellitus patients compared with healthy controls. Conclusion: The study results conclude that, fasting and post-prandial gallbladder volumes are indicative of gallbladder function. Patients with type 2 diabetes mellitus showed statistically significant impairment of gallbladder function. Gallbladder function may be evaluated routinely in type 2 diabetes mellitus patients.

SAT-LB6 First Human Trial of an Oral Native Testosterone Shows Physiological Levels of Testosterone and Dht in Both Fasted and Fed State in Hypogonadal Men

Introduction: The prevalence of male hypogonadism is estimated to be 6% in the USA (1). Current therapies have limited acceptability: gels can be messy and risk inadvertent dosing of others; injections are painful; and oral testosterone undecanoate (TU) delivers variable testosterone levels, requires concurrent ingestion of a fatty meal and may produce supraphysiological dihydrotestosterone (DHT) levels. We present the first human trial of an oral native testosterone preparation formulated to deliver physiological levels of testosterone irrespective of food intake. Aim: To compare the pharmacokinetics of DITEST (Diurnal Ltd Cardiff, UK) to an oil based oral TU formulation (Andriol Testocaps MSD, UK) and explore the effect of food on DITEST bioavailability. Methods: Single centre, phase 1b study of DITEST in 25 adult males with hypogonadism, one subject withdrawn after single period and only included in safety analysis (Clinicaltrials.gov: NCT02966652). Part 1 compared the pharmacokinetics of 80mg TU with 120mg DITEST after a high fat meal. Part 2 the pharmacokinetics of 200mg of DITEST administered in either fed or fasted states. Results are baseline adjusted. Results: DITEST showed a testosterone dose response between 120mg and 200mg with Cmax 550 (19.1) and 877 (30.4) ng/dl (nmol/l) and AUC0-10h 59.5 and 88.6 h*nmol/L. DITEST 200mg gave an equivalent Cmax and AUC0-10h to TU 80mg: Cmax 877 (30.4) vs 906 (31.4) ng/dl (nmol/l) and AUC0-10h 88.6 vs 102 h*nmol/L. Fed and fasted DITEST had similar pharmacokinetics: Cmax 764 (26.5) vs 877 (30.4) ng/dl (nmol/L), AUC0-10h 87.0 vs 88.6. DITEST resulted in lower levels of DHT than TU: Cmax 84 (2.9), 131 (4.5) & 194 (6.7) ng/dl (nmol/l); AUC0-10h 11.0, 16.7 & 36.3 h*nmol/L for DITEST 120mg, 200mg & 80mg TU, respectively. There was one serious adverse event (urinary retention) in the study during TU dosing. There were no emerging safety concerns, and adverse event frequency and severity was similar between the two treatments. Discussion: These results demonstrate that 200mg DITEST provides similar testosterone exposure with more physiological DHT exposure than 80mg TU given with a high fat meal. Administration of DITEST in fed and fasted states provides similar testosterone and DHT exposure. Compared to published literature on a self-emulsifying formulation of TU at 200mg, DITEST at 200mg provides a similar testosterone Cmax and no requirement for a fatty meal (2). Conclusion: DITEST is an oral native testosterone formulation with anticipated advantages over current oral therapy of dosing without food and a lower risk of supraphysiological DHT levels.

The effect of fatty meal and water on interfering extracardiac activity in myocardial perfusion single-photon emission computed tomography

BackgroundThere are several ways to diagnose coronary artery disease. Myocardial perfusion imaging (MPI) is used for the diagnosis of coronary artery disease. One of the practical challenges in scan’s interpretation is interfering liver radiotracer uptake with appropriate cardiac visualization. For many years, different approaches were evaluated for conquering this problem. A relatively common method is using fat-containing meals before imaging. Fatty meals may cause some problems for some patients, especially elderly with digestive disorders, as well as an extra cost. We designed a study to compare the efficacy of water and fatty meal as a liver clearing agents to facilitate MPI results interpretation.ResultTotally, 30 patients (consist of 30 stress phases and 30 rest phases), including 18 women and 12 men, were evaluated. The fatty meal was used before 32 scans and cold water in the other 28 scans. Finally, 40 scans had the suitable quality for reporting by nuclear physicians among 60 scans, which included 20 of 28 scans with water and 20 of 32 scans with a fatty meal.ConclusionsThis comparison showed that scans performed with the water group had similar results with the fatty meal group. Water is better than fatty meals because of its ease of use and lower cost. Therefore, the use of water can be a good alternative for routine use in NM centers.

Effect of Dietary Macronutrients on Postprandial Glucagon and Insulin Release in Obese and Normal-Weight Women.

The aim of the study was to assess the effect of dietary macronutrients on circulating glucagon and insulin levels in obese and normal-weight women. Potentially, the impaired release of glucagon may proceed abnormal glucose metabolism in obese patients ahead of overt diabetes. In 20 insulin-sensitive women (11 obese and 9 normal-weight), plasma concentrations of insulin and glucagon levels were assessed before and after 3 different macronutrient test meals. AUCtotal insulin in the obese group was increased after protein and carbohydrates compared to fatty test meal consumption (3981 ± 2171 and 4869 ± 2784 vs. 2349 ± 1004 μIU∗h/m, p < 0.05, respectively), but without a difference between protein and carbohydrates ingestion. However, in the normal-weight group, AUCtotal insulin was increased after carbohydrates compared to fatty test meal ingestion (3929 ± 1719 vs. 2231 ± 509 μIU∗h/ml, p < 0.05) and similar after carbohydrate and protein as well as after fatty and protein test meals (3929 ± 1719 vs. 2231 ± 509 vs. 3046 ± 1406 μIU∗h/ml, respectively). However, AUCtotal insulin was significantly increased in obese compared to normal-weight women only after carbohydrate test meal ingestion (4869 ± 2784 vs. 3929 ± 1719 μIU∗h/ml, p < 0.05). AUCtotal glucagon was similar after carbohydrate, protein, and fatty test meals ingestion in obese and normal-weight women (921 ± 356 vs. 957 ± 368 vs. 926 ± 262 ng∗h/ml and 1196 ± 14 vs. 1360 ± 662 vs. 1792 ± 1176 ng∗h/ml, respectively). AUCtotal glucagon was significantly lower in obese than normal-weight women after a fatty meal (926 ± 262 vs. 1792 ± 1176 ng∗h/ml, p < 0.01). Postprandial glucagon secretion is not related to the macronutrient composition of the meal in normal-weight women since postprandial glucagon concentrations were stable and did not change after carbohydrate, protein, and fatty test meals. Lower glucagon secretion was observed in obese subjects after fatty meal consumption when compared to normal-weight subjects. Postprandial insulin profile was significantly higher after carbohydrate than fatty test meal intake in the obese group and did not differ between obese and normal-weight groups after carbohydrate, protein, and fatty test meals consumption. Impaired glucagon secretion after fatty meat suggests early pancreatic alpha-cell dysfunction, after a carbohydrate meal is a compensatory mechanism.

HIDA and Seek: Challenges of Scintigraphy to Diagnose Bile Reflux Post-Bariatric Surgery.

Oesophageal bile reflux after bariatric surgery may trigger development of Barrett's oesophagus. Gastro-oesophageal reflux of bile is captured by hepatobiliary iminodiacetic acid (HIDA) scintigraphy; however, anatomical and physiological changes after bariatric surgery warrant protocol modifications to optimise bile reflux detection. HIDA scintigraphy occurred 6months after either sleeve gastrectomy, Roux-en-Y gastric bypass or one-anastomosis gastric bypass. Standard HIDA scanning involves (i) 6-h fast and 24-h abstinence from opioids; (ii) IV administration of 99mTc di-isopropyl iminodiacetic acid; and (iii) dual anterior/posterior 60-min dynamic scanning of the duodenum, stomach and oesophagus. Three challenges were identified, and modifications were implemented, namely, (1) anatomical localisation of refluxed bile on planar scintigraphy was improved by adding a SPECT/CT for 3D imaging; (2) impaired cholecystokinin-controlled gallbladder emptying, following bypassed duodenum, was addressed by ingestion of a 'fatty meal'; and (3) intestinal hypomotility after gastric bypass was counteracted by longer scan duration (75-90min) to allow bile to pass beyond the gastro-jejunal anastomosis. HIDA scan was undertaken in 18 patients, 13 of whom underwent the modified protocol. The tailored protocol ameliorated issues identified with the standard HIDA scan protocol; thus, accurate anatomical localisation was achieved in all patients, no delayed gallbladder emptying was observed, and bile was observed beyond the gastro-jejunal anastomosis in all gastric bypass patients. The modified technique was well tolerated by patients. A tailored HIDA scan protocol with addition of a SPECT-CT scan, ingestion of a fatty meal and prolonged scanning duration results in enhanced bile reflux detection in post-bariatric surgical patients.

Case report of one month and 15\u2009days old baby with type V hyperlipoproteinemia (HLP)

BackgroundMost of the patients with type 1 and V hyperlipoproteinemia (HLP) present with symptoms and signs of acute pancreatitis due to marked elevation of triglycerides, but this baby presented with a chest infection, which was later diagnosed as type V HLP on laboratory workup.Case presentationWe report a case of a 1 month and 15 days old baby boy, product of 2-nd degree consanguinity admitted to a nearby hospital with complaints of refusal to feed, cough and excessive crying. On examination his heart rate was 102 beats/min, respiratory rate was 55 breaths/min and temperature was within the normal range, provisional diagnosis of Pneumonia was made. His samples were tested at our laboratory, the lipid Profile at age of 1 month 15 days showed total cholesterol (TC) of 1400 mg/dl reference range (RR < 200 mg/dl), triglycerides (TG) of > 885 mg/dl after dilution it was 31,400 mg/dl (RR < 150 mg/dl), High density Cholesterol (HDL) of 35 mg/dl (RR > 40 mg/dl) and low density cholesterol (LDL) of 200 mg/dl (RR < 100 mg/dl). The patient’s blood sample was grossly milky and lipemic in appearance. A “Refrigerator test” was performed after overnight storage of the sample in refrigerator at 4 °C, which gave a creamy layer at the top and clear infranatant due to caking of the Chylomicrons. Lipoprotein electrophoresis performed 1 month later showed Chylomicrons of 4.7% (RR 0–2%), Pre-beta lipoproteins of 51.5% (RR 5–22%), beta lipoproteins of 16.5% (RR 39–70%) and alpha of 27.3% (RR 23–53%). Initially he was diagnosed as type 1 HLP, but later on he was correctly diagnosed as type V HLP. Cholestyramine (Questran sachet) powder was started at a dose of 100 mg/kg on t.i.d basis with NAN-1 formula Milk at the age of 1 month and 15 days. On follow up, detailed advices regarding the weaning food was given to the mother (using olive oil in cooking, giving proteins and avoiding heavy fatty meals). His lipid profile was repeated at age of 3 months, which showed some improvement, his TGs were 1986 mg/dl and TC 105 mg/dl.ConclusionThere is no universal diagnostic criterion for diagnosing Type V HLP, most likely, due to a scanty literature on this disorder. It stimulated us to report this case so that our findings may help for a timely diagnosis of the affected patients.

Do nutritional behaviors depend on biological sex and cultural gender?

Conventional knowledge, resulting from observations and experience, maintains the conviction that there are gender differences in the acquisition, preparation and consumption of food. This review shows differences between the sexes in eating behavior, food choice and nutritional strategy which were conditioned by evolution and by intra-individual (biological or psychological) and extra-individual (socioeconomic and cultural) factors. Women manifest a more pronounced trust in healthy nutrition, greater engagement in controlling body weight, a higher tendency to eat in a group and in stressful situations, and they frequently experience frustration due to their own nutritional behaviors, which reflects higher social pressure and their attempts to reduce eating-related pleasure. On the other hand, men prefer fatty meals with a strong taste, and are directed mainly by the pleasure of consumption; they more frequently furtively eat sweet foods while watching television, use more dietary supplements and more frequently visit fast food restaurants. Nutritional behavior, styles of nutrition, dietary profiles, approach to nourishment, approach to the place of meal consumption, and the sources of nutritional knowledge all demonstrate associations with gender. Reciprocal interactions between gender and diet are conditioned by physiological, psychological and sociocultural factors. This system of reciprocal interactions includes feedback: biological sex and cultural gender shape one's diet and, reciprocally, one's diet affects the deepening or flattening of gender differences. The analysis of reciprocally interacting factors entangled in the formation of a nutritional model may also represent an important element of pro-health prophylaxis and should be used in medical and dietary practice. Males in particular should be informed and educated about health-promoting diets.

Comparison of Fatty Meal, Drotaverine and Hyoscine for Duodenal Anti-motility and Cannulation During ERCP- A Randomised Controlled Trial

Introduction: Endoscopic Retrograde Cholangiopancreatography (ERCP) is a technically demanding procedure that requires considerable amount of training to be performed safely. Successful cannulation of the ducts depends on the expertise of the endoscopist. Conventionally, cannulation is facilitated with the help of smooth muscle relaxants like Hyoscine-N-butyl bromide or Drotaverine which impair duodenal contractions and facilitate sphincter of oddi relaxation. Aim: To compare the effect of Fatty meal versus Drotaverine hydrochloride versus Hyoscine-N-butyl bromide on duodenal contraction rate, ease of identification of the papillary orifice, time for cannulation, and adverse effects of agents used on haemodynamic parameters. Materials and Methods: The study was conducted at Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai,Tamil Nadu, India, where 60 patients admitted for ERCP with normal appearing ampulla, were taken-up for the study. Patients were subjected randomly into the three groups viz., Hyoscine group, Drotaverine group and Fatty meal group. In Fatty meal group, 200 mL of semi skimmed milk (1.7% fat) was given orally one hour prior to the procedure to allow for gastric emptying. A 20 mg of intravenous Hyoscine-N-butyl bromide and 40 mg of intravenous Drotaverine hydrochloride were administered 15 minutes before procedure in Hyoscine and Drotaverine group, respectively. Statistical analysis was done by Chi-square test and Analysis of Variance (ANOVA) test and using Statistical Package for the Social Sciences (SPSS) 16.0 version software. A p-value &lt;0.05 was considered significant. Results: The difference in duodenal motility, cannulation time and success of the procedure did not show a statistically significant p-value between the three groups. The identification of ampulla was easy with the fatty meal group. The statistical analysis for intraprocedural change in pulse rate and Blood Pressure (BP) variation showed a significant p-value for Hyoscine group compared to the other two groups. The change in pulse rate for Hyoscine vs. Drotaverine vs. Fatty meal group during the procedure was 51.5±12.8 vs. 24.2±8.4 vs. 24.4±8.8 per minute, respectively. The variation in BP during the procedure was 18.3/15.7±7.7/9.0 mmHg vs. 9.0/8.7±5.7/5.6 mmHg vs. 10.4/8.6±4.6/3.3 mmHg for Hyoscine vs. Drotaverine vs. Fatty meal group respectively. Conclusion: Fatty meal is not inferior to the conventionally used Hyoscine-N-butyl bromide or Drotaverine for its anti-motility effect on the duodenum during ERCP. The cannulation time is no different within the groups. Fatty meal, the action of which is physiological may be used as a suitable alternative to antispasmodic pharmacological agents which have potential adverse effects.

High-saturated fatty meals with orange juice intake have subjective appetite sensations suppressed: Acute, postprandial study.

To elucidate the acute effect of different high-fat meals accompanied by water or orange juice on subjective appetite sensations. This acute, postprandial study included 39 healthy women (aged 20 to 40 years): 22 participants received a high-monounsaturated fat meal (MUFA) (≈1000 kcal, 56.3% Energy from MUFA) and 17 participants received a high-saturated fat meal (SFA) (≈1000 kcal, 37.6% Energy from SFA). Both interventions were accompanied by 500 ml of water or orange juice. The subjective appetite sensations were evaluated before (fasting) and 1, 2, 3, 4, and 5 hours after the meal intake using the visual analog scale. The subjective area under curve (AUC) appetite sensations and AUC appetite scores were equal after the consumption of high-fat meals from SFA and MUFA. Moreover, the consumption of a high-SFA meal raises the prospective desire to eat something fatty. In addition, the high-SFA meal consumption reduces subjective AUC appetite sensations and AUC appetite scores along the time, compared to a high-MUFA meal, when orange juice consumption followed those meals. Our results demonstrate that high-MUFA meal consumption decreased the desire to intake something fatty, and the high-SFA meal, when followed by orange juice intake, has postprandial appetite sensations suppressed.

Factors influencing conversion of laparoscopic cholecystectomy into open cholecystectomy

Background: Laparoscopic cholecystectomy may be rendered difficult by various problems encountered during surgery, such as difficulty in accessing the peritoneal cavity, creating a pneumoperitonium, dissecting the gall bladder, pericholecystic adhesions and adhesions between the common bile duct the cystic duct and the cystic artery (calot’s triangle) or extracting the excised gall bladder, injury to common bile duct, bowel and iliac vessels. These conditions may lead surgeons to perform conventional open cholecystectomy.Methods: The general biodata was collected. A detailed history was taken with special reference to duration of right upper quadrant pain or epigastric pain, its periodicity, its aggravation by fatty meals and relief by oral or parental analgesics. Fever, jaundice or any previous attacks of cholecystitis. A relevant general physical examination and systemic examination was done and findings recorded, routine laboratory investigation was done. All cases were then subjected to ultrasound examination with 2-5MHz curvilinear array transducer with an aim to assess.Results: The univariate analysis sex proved to be significantly predictive of conversion in the present study. Execution of ERCP before the intervention proved associated with an increased risk for conversion in our study. Stone position as significant factor for conversion while stone size was not significant. No significant association between fever and conversion our study.Conclusions: Male gender, GB wall thickness, stone position, stone size, ultrasound signs of pericholecystitis, acute cholecystitis, were significantly associated with conversion.