Pound Of Weight Research Articles

Enteric methane output and weight accumulation of Nguni and Bonsmara cows raised under different grazing conditions

Several experts throughout the world have focused a lot of their research on the rise in methane concentrations in the atmosphere and its causes. Cattle are the livestock species that contribute the most to methane emissions, according to research conducted over the previous three decades. A greenhouse gas called enteric methane (CH4) is created by microbial fermentation in the rumen and is released into the atmosphere through a variety of excretory processes. To reduce methane emissions, research on the ways that various breeds of cattle are reared on different grazing regimes should be prioritized. The goal of the current study was to measure the weight gain and intestinal methane emission of Nguni and Bonsmara cows grown under various grazing conditions. Eighty-four cows belonging to the 2 grazing systems were randomly selected and grouped according to three age groups: A (young adult cow, n = 7, 24–48 months), B (adult, n = 7, 60–80 months), and C (old adult, n = 7, 90–120 months) are three different age groups for adult cows. Methane production was higher per head in older animals, with C producing the most, followed by B and A (C > B > A; P 0.0001). In Bonsmara, body condition, body weight (BW), dry matter intake (DMI), and daily methane were all higher (P 0.05). Nguni had more methane per pound of weight (P 0.05), although methane per kilogram of body mass (P > 0.05) was similar across breeds. In the commercial system, body condition, BW, and DMI were higher (P 0.05). On the other hand, communal grazing resulted in increased daily methane production, methane per DMI, and methane produced per BW. These findings support the notion that breed genetics, grazing system, and age all have an impact on methane levels and performance. So, all these aspects must be taken into account in breeding strategies for traits like methane production that are challenging to assess.

PSAT328 Primary Hypothyroidism Presenting with Galactorrhea and Pituitary Hyperplasia

Abstract Introduction Pituitary Hyperplasia (PH) refers to diffuse enlargement of pituitary gland and is most commonly physiological as in pregnancy and lactation. PH can also be associated with end organ hormone deficiencies like primary hypothyroidism, Addison's disease and some neuroendocrine tumors. Primary hypothyroidism is a known cause of prolactin elevation however hyperprolactinemia in the presence of pituitary enlargement can often be mistaken for pituitary adenoma. We report a case of PH caused by primary hypothyroidism presenting with galactorrhea and hyperprolactinemia and successfully treated with thyroid hormone replacement. Case presentation 21-year-old female presented to the Primary Care Provider's office with galactorrhea from bilateral breasts for 2 months. Pregnancy was ruled out and prolactin levels were checked and noted to be elevated at 51.3 ng/mL. Subsequently MRI of Pituitary was done which showed diffusely enlarged, homogenously enhancing anterior pituitary gland with convex superior margin, measuring 12 mm in superior to inferior dimension, contacting and slightly elevating optic chiasm. Further testing showed TSH >100µIU/mL, and undetectable Free T4. She was started on Levothyroxine and then referred to Endocrinology for evaluation of Pituitary mass. Upon further questioning she reported headaches for few weeks associated with intermittent dizziness, fatigue, weight gain of 30-40 pounds, irregular menstrual periods, cold intolerance, and low libido for several months. Physical exam was remarkable for bradycardia, dry skin. Thyroid was normal on exam. Pituitary hyperplasia was thought to be secondary to primary hypothyroidism and patient was continued on Levothyroxine. At 3 month follow up visit, patient reported improvement in her symptoms of fatigue, menstrual periods and lost few pounds of weight. Her galactorrhea resolved completely. Repeat labs showed normal prolactin levels and her thyroid levels normalized after few dose adjustments. Follow up MRI done 1 year from initial presentation showed decrease in the anterior pituitary enlargement, now measuring 8 mm, and the superior margin was no longer contacting the optic chiasm. Conclusion Primary hypothyroidism is common, but often under recognized cause of Pituitary hyperplasia. The underlying pathophysiology is lack of negative feedback of Thyroid hormones on Hypothalamus resulting in elevated levels of Thyrotropin releasing hormone (TRH). Excess TRH leads to thyrotroph cell hyperplasia in anterior pituitary and elevated TSH levels, TRH also leads to lactotroph hyperplasia and can result in hyperprolactinemia. Neurological symptoms related to PH and symptoms related to hyperprolactinemia, can sometimes be the initial presenting symptoms of primary hypothyroidism. It is important to recognize primary hypothyroidism as the cause for pituitary hyperplasia and hyperprolactinemia (especially those with TSH > 50-100 microIU/mL) as the primary treatment is thyroid hormone replacement and not surgery. These patients should be followed closely with repeat MRI to document the resolution of pituitary hyperplasia. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

PSUN238 COVID 19 induced Type 1 Diabetes Mellitus

Abstract Introduction There have been some case reports where patients presented with uncontrolled hyperglycemia without previous diagnosis of diabetes but very limited literature supporting the fact that COVID 19 infection can lead to the development of new onset Type 1 diabetes. Clinical Case A 30-year-old African American man presented to the office with a diagnosis of new onset DM towards the end of March 2021. He did not have any significant medical history other than prediabetes with a prior HbA1c of 6% and COVID 19 infection in 2020. He had no family history of DM. He was very sick with the COVID 19 infection and lost 20 pounds of weight around that time. He did not get hospitalized and did not have any blood work done. A couple of months after recovery from his COVID 19 illness he developed leg cellulitis. He decided to seek help for this problem and was started on some antibiotics and antifungals, but they did not help much. His leg swelling and pain did not improve so he went to the ER. At that time his work-up showed a HbA1c of 15.5%. Patient was also having polydipsia and polyuria by that time. He was given a new set of antibiotics and was discharged to follow-up with a primary care provider. His PCP started him on Metformin and Lantus insulin for new onset DM2. He was then referred to Endocrinologist for further management. At the time of his endocrine office visit his symptoms of polyuria and polydipsia had improved a lot.His Anti GAD 65 antibodies were positive with a value of 41 (neg <5). C-peptide level was 1.9 which was in the range (1.1-4.4). IAA–2 autoantibodies were positive with a value of more than 120 (neg<7.5). ZNT 8 antibodies and Insulin antibodies were negative. An increase in the number of antibodies is associated with a higher likelihood of type 1 DM. Only less than 3% of type 2 diabetics have positive antibodies. As per the laboratory interpretation our patient had type 1 diabetes. After starting insulin treatment, the HbA1c improved to 6.6% from 15.5%. Patient is currently on continuous glucose monitoring with insulin therapy and has a good glycemic control. Conclusion Our case highlights the importance that SARS-CoV-2 infection is an independent risk factor for the development of new onset type 1 DM and increased risk of complications in preexisting diabetics. There have been studies showing that patients who presented with DKA precipitated by COVID-19 infection had worse outcomes than patient's presenting with DKA without COVID-19 infection. Mortality was higher for COVID-19 in diabetic patients as well. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Mobile and Portable De-Icing Devices for Enhancing the Distribution System Resilience Against Ice Storms: Preventive strategies for damage control

Climate change has reportedly increased the frequency and intensity of extreme weather events such as heatwaves, heavy rains, hurricanes, tornados, flood, fire, and ice storms. Ice storms are considered one of the most severe natural disasters that can disrupt people's daily lives and incur infrastructural damages. As shown in Figure 1, the accumulated weight of ice on surfaces can easily snap trees and power lines and damage distribution and transmission structures. Just six to seven millimeters of ice accumulation can add hundreds of pounds of weight per line span. Ice storms are the leading cause of large-scale power outages in the United States and elsewhere during the winter season. The damage caused by ice storms can easily result in major power outages, blackouts, and at times shut down entire metropolitan areas.

S2887 Diffuse Large B-Cell Lymphoma Presenting as Jejunal Diverticulitis on Imaging

INTRODUCTION: Small bowel tumors comprise of only 5% of all neoplasms in the gastrointestinal tract. The diagnosis of small bowel tumors is often difficult due to the rarity of these lesions and the non-specific and variable presenting signs and symptoms. This can lead to a delay in diagnosis and poor treatment outcome. Frequently, small bowel tumors are diagnosed on imaging and confirmed by endoscopy. We describe a case of jejunal diffuse large B-cell lymphoma which was initially read as jejunal diverticulitis on imaging. CASE DESCRIPTION/METHODS: Our patient is a 60-year-old male with poorly controlled diabetes, hypertension, hyperlipidemia, and COPD who presented with abdominal pain, nausea, and vomiting. Abdominal pain was dull in nature, located around the umbilical area, and had been going on for about a month. He had made multiple emergency department visits for similar symptoms in the prior weeks. Also, he lost about 20 pounds of weight and had decreased appetite over the last 3 months. CT scan of the abdomen showed inflammatory changes surrounding the proximal jejunum (Image 1) characterized as jejunal diverticulitis. He was given antibiotics without any improvement in symptoms. Eventually, a push enteroscopy was performed which showed a partially obstructing mass just distal to the duodenojejunal junction (Image 2). Tattoos were placed proximally and distally for marking. Biopsy was diagnostic of diffuse large B-cell lymphoma. PET scan was performed which showed localized disease with adjacent lymph node involvement. Patient underwent surgical resection of the tumor due to concern of bowel perforation followed by chemotherapy. DISCUSSION: Tumors in the small bowel are exceedingly rare and can easily be overlooked as their presenting symptoms are bizarre and non-specific. The most common symptoms are pain, obstruction, and bleeding while perforation can rarely occur as well. Abdominal imaging is usually the first line modality to figure out the etiology of these symptoms. Imaging usually shows some abnormalities in these cases but is not confirmatory and at times may lead to other diagnoses as was the case in our patient. Patient’s history should be considered when figuring out the diagnosis in these cases. If there are any alarming symptoms such as weight loss, decreased appetite, or no improvement after initial treatment then there should be a high index of suspicion for small bowel tumors and endoscopy should be performed as early detection is the most important prognostic factor in these cases.Figure 1.: Inflammatory changes around the jejunal area read as jejunal diverticulitis.Figure 2.: Partially obstructing mass seen on enteroscopy distal to duodenojejunal junction.

Association Between Weight Loss and Glycemic Outcomes: A Post Hoc Analysis of a Remote Patient Monitoring Program for Diabetes Management.

Background: Evidence-based guidelines for the management of type 2 diabetes (T2D) consist of blood glucose monitoring, medication adherence, and lifestyle modifications that may particularly benefit from reminders, consultation, education, and behavioral reinforcements through remote patient monitoring (RPM). Objectives: To identify predictors of weight loss and to examine the association between weight loss and hemoglobin A1C (HbA1C) outcomes for T2D patients who were enrolled in an RPM program for diabetes management. Materials and Methods: The study applied logistic and ordinary least-squares regression models to examine the relationship between baseline characteristics and the likelihood of weight loss during the RPM, and how the magnitude of weight loss was related to changes in HbA1C outcomes for 1,103 T2D patients who went through 3 months of RPM from 2014 to 2017. Results: Older patients were 3% more likely to have weight loss (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.02-1.05), whereas patients with higher baseline HbA1C had 9% reduced odds (OR, 0.91; 95% CI, 0.85-0.97) of experiencing weight loss. For every pound of weight lost, there was a 0.02-point (95% CI, 0.01-0.03) reduction on the HbA1C measured at the end of the RPM. Moreover, compared with those who had weight loss of ≤3%, participants who had lost 5-7%, or >7% of their baseline weight had a 0.37- and 0.58-point reduction in HbA1C, respectively. Conclusions: This study revealed a notable relationship between weight loss and positive HbA1C outcomes for T2D patients in an RPM-facilitated diabetes management program, which pointed to the potential of integrating evidence-based lifestyle modification programs into future telemedicine programs to improve diabetes management outcomes.

SUN-595 Chronic Diarrhea as a Manifestation of Medullary Thyroid Cancer

Background: Tumor secretion of calcitonin (Ct), Ct gene-related peptide, or other substances can cause diarrhea in patients with advanced medullary thyroid cancer (MTC). We report 3 patients with chronic diarrhea due to MTC in whom the diagnosis was delayed. Case 1: A 26-year-old man reported to Gastroenterology (GI) clinic with a 6-month history of diarrhea. An extensive work-up was performed including upper and lower endoscopies that were unrevealing. A diagnosis of chronic diarrhea of unknown etiology was made and patient received symptomatic treatment. Six months later the patient lost about 16 pounds of weight; a chest CT was performed showing a left thyroid mass with cervical lymphadenopathy and skeletal metastases. Biopsy of the thyroid mass confirmed MTC. Serum calcitonin (Ct) level was 52894 ng/L (ref <10). Additional tests (serum VIP, somatostatin, glucagon, pancreatic polypeptide, neurotensin, and gastrin levels) were normal. Two months post thyroidectomy and lymph node dissection, Ct level was 447 ng/L and diarrhea improved. Subsequently serum Ct started rising and imaging studies showed extensive metastases and presently patient is treated with tyrosine kinase inhibitors. Case 2: A 27-year-old woman was referred to GI clinic with a 3-month history of diarrhea. Upper endoscopy and colonoscopy were noncontributory. Detailed laboratory evaluations were normal and a diagnosis of irritable bowel syndrome was made. One month later, thyroid nodules were detected and biopsy of the thyroid nodule revealed MTC. Serum Ct was 2890 ng/L. Patient underwent total thyroidectomy and histology confirmed MTC with metastasis. Two months later, serum Ct was 490 ng/L with improvement in diarrhea and reduced loperamide dosage. Case 3: A 38-year-old man was referred to GI clinic with a 4-month history of diarrhea. Patient underwent a detailed evaluation and was treated with loperamide and tincture of opium with partial improvements. Three months later, a physical examination revealed a 4-cm left thyroid nodule and biopsy suggested MTC. Serum Ct level was 4088 ng/L. Patient underwent total thyroidectomy and lymph node dissection. Histology confirmed MTC. Two months postoperatively, serum Ct level normalized and diarrhea completely resolved. Discussion The link between tumor humoral secretion and diarrhea is well established in patients with MTC as diarrhea is more frequent with metastatic disease and immediately improves after resection of the tumor. The improvement in diarrhea was seen in our patients postoperatively. Diarrhea may result from a secretory process induced by elevated circulating Ct or other substances such as prostaglandin or serotonin. Other proposed mechanisms include decreased absorption in the colon secondary to motor disturbances. In conclusion, MTC should be considered when evaluating chronic diarrhea.

Proximal muscle weakness

A 38-year-old woman gave a 1-year history of difficulties climbing stairs and walking long distances, needing a wheelchair at times. More recently, she had also experienced weakness of her arms...

Thermographic images from healthy knees between dogs with long and short hair

ABSTRACT: The aim of this study was to investigate the influence of fur length in the evaluation of knees temperature in healthy dogs, using infrared thermography. This is a non-invasive diagnosis that is able to assess the microcirculation of the internal skin. Changes in temperature reflect from inflammatory reactions and vascular infarction to neurological disorders. Knees of 30 healthy dogs were analyzed, with up to 11 pounds of weight, screened by clinical examination and radiographic examination. Group A, consisting of 13 dogs with short fur, with 26 knees evaluated in total. Group B included animals with long fur, consisting of 17 animals, with 29 knees evaluated in total. The average temperatures of the cranial, lateral, caudal and medial sides of knees were analyzed. A significant difference between the groups was observed, with group A temperature being greater than the group B in all four analyzed faces. Comparing the temperatures of the faces in the contralateral limb, in both groups, the statistical analysis revealed no significant difference. In group A it was observed that temperatures in the cranial and lateral sides were similar, but different from the others. In group B, the statistical analysis showed the cranial lateral and caudal faces was similar, but differed from the medial side. The thermographic examination proved to be sensitive in the evaluation of temperature of small dogs’ knees;however, the length of the fur influenced the result.

An examination of the increases in pedestrian motor-vehicle crash fatalities during 2009–2016

IntroductionPedestrian fatalities increased 46% in the United States during 2009–2016. This study identified circumstances under which the largest increases in deaths occurred during this period. MethodAnnual counts of U.S. pedestrian fatalities and crash involvements were extracted from the Fatality Analysis Reporting System and General Estimates System. Poisson regression examined if pedestrian fatalities by various roadway, environmental, personal, and vehicle factors changed significantly during 2009–2016. Linear regression examined changes over the study period in pedestrian deaths per 100 crash involvements and in horsepower per 1000 pounds of weight among passenger vehicles involved in fatal single-vehicle pedestrian crashes ResultsPedestrian deaths per 100 crash involvements increased 29% from 2010, when they reached their lowest point, to 2015, the most recent year for which crash involvement data were available. The largest increases in pedestrian deaths during 2009–2016 occurred in urban areas (54% increase from 2009 to 2016), on arterials (67% increase), at nonintersections (50% increase), and in dark conditions (56% increase). The rise in the number of SUVs involved in fatal single-vehicle pedestrian crashes (82% increase) was larger than the increases in the number of cars, vans, pickups, or medium/heavy trucks involved in these crashes. The power of passenger vehicles involved in fatal single-vehicle pedestrian crashes increased over the study period, with larger increases in vehicle power among more powerful vehicles. ConclusionsEfforts to turn back the recent increase in pedestrian fatalities should focus on the conditions where the rise has been the greatest. Practical applicationsTransportation agencies can improve urban arterials by investing in proven countermeasures, such as road diets, median crossing islands, pedestrian hybrid beacons, and automated speed enforcement. Better road lighting and vehicle headlights could improve pedestrian visibility at night.

Abstract 191: Plan-Based Diet and Lifestyle Changes Improve Stress Test Induced ST Depression in 18 Days

Background: This study documents the effects of an intensive 18-day lifestyle program on EKG stress test readings of the ST segment. Improving EKG readings could be a positive indicator of cardiovascular improvement. Methods: The medical residential program takes place in Weimar California. The intervention could be summarized in the word NEWSTART which means Nutrition, Exercise, Water, proper Sunlight exposure, fresh Air, Rest and Trust (in relational, spiritual, and psychological aspects). Physicians, nutritionist, exercise physiologist, physical therapist, psychological and spiritual counselors are part of the team. Every patient does a treadmill test (using the Bruce protocol) before and after the 18 day program and a before and after blood tests. Board certified physicians monitored the progress of each patient. Data from 11 years of retrospective recordings were used. From n=2091 patients in the data base, n=145 were used in the study because they had a stress test induced ST depression of 2 mm on two EKG leads or more at baseline. No angiography was available at the institution. Results: Average age of patients was 64 (SD 10.5), n=81 (56%) female, and n=131 (90%) were Americans. At baseline the group with ST depression in more than two leads had a mean ST depression in mm of 3.9, SD 2.3, max 13, median 3, mode 2 in the most affected lead. At the end of the 18 days the same group had a mean ST depression in mm was 2.7, SD 2.7, max 12, median 0, mode 0 on the most affected lead. After the 18 days the stress test reported that n=70 (48.2%) had improvement as seen in an improvement of the ST depression during the stress test. While n=64 (44.1%) had the same level of ST depression during the last stress test and n=11 (7.5%) worsen the ST depression during the end stress test. The changes in the ST segment were significant according to the paired t-test t(144)=5.421 with a p&lt;.001. The n=145 lost 4 pounds of weight on average (SD 4) at the end of the 18 days, No heart infarctions occurred during the intervention. Conclusion: The intensive lifestyle interventions seem to be effective in improving ST depression. Improvement of ST depression could improve long term prognosis. Further follow up is advised.

The £ for lb. Challenge. Evaluation of a novel, workplace-based peer-led weight management programme, 2014–2016

ObjectivesTo evaluate the £ for lb. Challenge, a novel country-wide, workplace-based, peer-led weight management programme with participants from a range of private and public organisations in Northern Ireland. Study designPre- and post-intervention studies. MethodsThe intervention was workplace-based, led by volunteer co-worker champions and based on the NHS Choices 12-week weight loss guide which incorporates dietary advice, physical activity, behaviour change methods and weekly weight monitoring. It operated from January to April in three consecutive years (2014–16). Overweight and obese adult workers were eligible. Training of peer champions involved two half-day workshops delivered by dieticians and physical activity professionals. Employers and/or participants pledged £1 to charity for every pound of weight lost. Weight was reported at enrolment and at either 12 weeks (2014) or at 12 weekly intervals (2015–16). Changes in weight and % weight, and body mass index were determined for all the participants and for gender and deprivation subgroups. ResultsThere were 734, 1559 and 1513 eligible participants, and 21, 31 and 35 participating companies in 2014, 2015 and 2016, respectively. Engagement rates were 94% and 96% and completion rates were 70% and 71% in 2015 and 2016, respectively. Mean weight loss was 1.9 kg (2.2%; 2014), 2.5 kg (2.8%; 2015) and 2.4 kg (2.7%; 2016). The proportions losing ≥5% initial bodyweight were 21% (2014), 24% (2015) and 26% (2016). Male participants were more than twice as likely as women to complete the programme (odds ratio: 2.5 [2015]; 2.2 [2016]) and to lose ≥5% bodyweight (odds ratio: 2.5 [2015]; 3.7 [2016]). ConclusionsThe £ for lb. Challenge was an effective, low-cost health improvement intervention with meaningful weight loss for many participants, particularly male workers. With high levels of engagement and ownership, and successful collaboration between public health, voluntary bodies, private companies and public organisations, it is a novel workplace-based model with potential to expand.

239 Sexual and Non-sexual Improvements in Women with HSDD: Personal Experiences with Flibanserin Treatment

As of October 2015 women with hypoactive sexual desire disorder (HSDD) have an FDA approved prescription medication available for treatment, flibanserin (Addyi). Pivotal clinical trials show a 40-60% response rate. With more than 130 of our patients prescribed flibanserin for HSDD, we retrospectively reviewed the personal reflections of those who responded favorably. Patients currently prescribed flibanserin were asked to share their experiences with the medication by email in an attempt to follow their progress. Responses were collected and later examined for responsivity to flibanserin, and for themes with regards to response time to the drug, short-term improvements, longer-term changes, and other general observations. Testimonials from 39 responders were analyzed. Average time to experiencing positive change in HSDD symptoms was 6 weeks (range 10 days-16 weeks). Responsive users have been on the drug for an average of 4 months (range 1-8 months). Improvements in HSDD symptoms were both sexual and non-sexual. Regarding HSDD, overall changes included increases in: sexual responsiveness, sexual thoughts/dreams, initiation of sexual activity, positive anticipation, articulation of sexual desires, and decreased inhibition from sexual Post Traumatic Stress Disorders (PTSD) related to physical and emotional abuse, trauma and previous sexual pain experiences. With regards to other non-HSDD sexual responses, respondents noted: intensified and/or faster lubrication/arousal, increased clitoral engorgement, stronger or increased number of orgasms, and enhanced sexual satisfaction. Non-sexual responses involved improved relationships including partners being more attentive, and mood changes such as having fun, feeling more alive, feeling less stressed and general happiness. One woman reported having “reignited her sexual self.” In addition, most respondents lost several pounds of weight, and most slept better. Some stopped all alcohol intake but others continued without consequences. No serious adverse events were noted.

375 Personal Experiences of Women Successfully Treated by Flibanserin at a Single Center

The first FDA approved medication for women with hypoactive sexual desire disorder (HSDD), flibanserin (Addyi), was available by prescription as of October 2015. Our center has over 120 patients prescribed flibanserin. Pivotal clinical trials show a 40-60% response rate. Our aim was to retrospectively review the personal reflections of those who responded favorably to flibanserin for use in HSDD. Patients currently prescribed flibanserin were asked via email to provide testimonial paragraphs concerning their experiences on flibanserin. Responses were collected and later examined for responsivity to flibanserin, and to themes with regards to response time to the drug, short-term improvements, longer-term changes, and other general observations. Testimonials from 32 responders were analyzed. Average time to experiencing positive change in HSDD symptoms was 6 weeks (range 10 days – 15 weeks). Responsive users have been on the drug for an average of 4 months (range 1-8 months). Improvements in HSDD symptoms were both sexual and non-sexual. With regard to HSDD, overall changes included increases in: sexual responsiveness, sexual thoughts/dreams, initiation of sexual activity, positive anticipation, articulation of sexual desires, and decreased inhibition from sexual Post Traumatic Stress Disorders (PTSD) related to physical and emotional abuse, trauma and previous sexual pain experiences. With regards to other non-HSDD sexual responses, respondents noted increases in: intensified and/or faster lubrication/arousal, clitoral engorgement, stronger or increased number of orgasms, and enhanced sexual satisfaction. Non-sexual responses involved improved relationships including partners being more attentive, and mood changes such as having fun, feeling more alive, feeling less stressed and general happiness. One woman reported having “reignited her sexual self.” Most respondents lost several pounds of weight, and most slept better. Most stopped social alcohol use but several continued without consequences. No serious adverse events were noted.

Weight Gain and Incident Diabetes Among HIV-Infected Veterans Initiating Antiretroviral Therapy Compared With Uninfected Individuals.

The health implications of weight gain after antiretroviral therapy (ART) for HIV infection are not well characterized and may differ from weight gain among uninfected individuals. We use data from the Veterans Aging Cohort Study to determine whether weight gain after ART has a similar association with incident type 2 diabetes mellitus (DM) as weight gained among HIV-uninfected (uninfected) individuals. We explored associations of weight gain and incident diabetes (A1c ≥ 6.5%), in the Veterans Aging Cohort Study, a national observational study of HIV-infected (HIV+) individuals demographically matched 1:2 to uninfected controls. From 2000 to 2011, weight change was assessed in the year following ART initiation for HIV+ individuals and date of first available body mass index for uninfected individuals. We estimated hazard ratios (HRs) and 95% confidence intervals (CIs) adjusted for baseline body mass index using Cox regression. HIV+ individuals had lower prevalence of DM at baseline (12% HIV+, 23% uninfected) and lower incident diabetes (5% HIV+, 11% uninfected). The association of weight gain with risk of DM was linear for HIV+ and uninfected but the slope of the association was steeper for HIV+. For each 5 pounds of weight gained, HIV+ had 14% increased risk of DM (HR, 1.14; 95% CI: 1.10 to 1.17) and uninfected individuals had 8% increased risk (HR, 1.08; 95% CI: 1.07 to 1.10) (P < 0.01 for interaction). Weight gained in the first year after ART initiation is associated with greater risk of DM than that among uninfected individuals. HIV+ individuals initiating ART who are not underweight should avoid substantial weight gain.

Landing on empty: estimating the benefits from reducing fuel uplift in US Civil Aviation

Airlines and Air Navigation Service Providers are united in their goal to reduce fuel consumption. While changes to flight operations and technology investments are the focus of a number of studies, our study is among the first to investigate an untapped source of aviation fuel consumption: excess contingency fuel loading. Given the downside risk of fuel exhaustion of diverting to an alternate airport, airline dispatchers may load excess fuel onto an aircraft. Such conservatism comes at a cost of consuming excess fuel, as fuel consumed is a function of, among other factors, aircraft weight. The aim of this paper is to quantify, on a per-flight basis, the fuel burned due to carrying fuel beyond what is needed for foreseeable contingencies, and thereby motivate research, federal guidance, and investments that allow airline dispatchers to reduce fuel uplift while maintaining near zero risks of fuel exhaustion. We merge large publicly available aviation and weather databases with a detailed dataset from a major US airline. Upon estimating factors that capture the quantity fuel consumed due to carrying a pound of weight for a range of aircraft types, we calculate the cost and greenhouse gas emissions from carrying unused fuel on arrival and additional contingency fuel above a conservative buffer for foreseeable contingencies. We establish that the major US carrier does indeed load fuel conservatively. We find that 4.48% of the fuel consumed by an average flight is due to carrying unused fuel and 1.04% of the fuel consumed by an average flight is due to carrying additional contingency fuel above a reasonable buffer. We find that simple changes in flight dispatching that maintain a statistically minimal risk of fuel exhaustion could result in yearly savings of 338 million lbs of CO2, the equivalent to the fuel consumed from 4760 flights on midsized commercial aircraft. Moreover, policy changes regarding maximum fuel loads or investments that reduce uncertainty or increase the ability to plan flights under uncertainty could yield far greater benefits.

An Unusual Complication of a Duodenal Ulcer

An 86-year-old man presented to the Emergency Department with a 6-week history of severe, intermittent, colicky abdominal pain and diarrhea. The stool was dark in color and he was opening his bowels 4 to 5 times a day. There was no nausea but his appetite was reduced and he had lost more than 14 pounds in weight. He had a past medical history of hypertension and was on 50 mg atenolol, 4 mg doxazosin, and 2 mg trandolapril daily. He lived independently and was the main carer for his wife, who suffered from dementia.

Abstract 18133: Between- and Within-Person Changes in Weight and Cardiorespiratory Fitness and the Effect on Blood Pressure and Lipids in Men and Women From the Cooper Center Longitudinal Study

Introduction: Cardiovascular disease (CVD) is the leading cause of death in the U.S. Controlling risk factors such as hypertension and dyslipidemia by maintaining a healthy weight and achieving an adequate level of cardiorespiratory fitness (CRF) could result in improvements in cardiovascular health. The Cooper Center Longitudinal Study is the most extensive resource available for evaluating the simultaneous effects of changes in weight and CRF on CVD risk factors. Objective: The purpose of this study was to evaluate the within-person relationships between body weight, CRF, and CVD risk factors, while controlling for the corresponding between-person relationships. We hypothesized that increases in weight and decreases in CRF over a ten-year time period would result in detrimental effects on blood pressure and lipids, and vice-versa. Methods: The study sample consisted of 4,439 men and 651 women who had at least 5 preventive medical examinations during any ten year period from 1977 to 2006. The examination included a maximal exercise test, anthropometric and clinical measures, and a medical history questionnaire. Linear mixed-effects regression was used to model the cardiovascular risk factors over time, providing estimates of between- and within-person effects. Results: Aging alone did not significantly predict changes in CVD risk factors in women or men after adjustment for covariates including CRF and weight, with the exception of total and LDL cholesterol in men. Increases in body weight were associated with increases in systolic and diastolic blood pressure, total cholesterol, LDL, and triglycerides and decreases in HDL in women and men. The largest effect of weight gain for women and men was seen in triglycerides, with a 2.29 mg/dL and 3.57 mg/dL increase per pound of weight gained per year, respectively ( P &lt; 0.001). Increases in CRF were associated with improvements in diastolic blood pressure [-0.39 mmHg (women); -0.10 mmHg (men)] and HDL [0.35 mg/dL (women); 0.63 mg/dL (men)] over time and in triglycerides (-2.26 mg/dL) in men only ( P &lt; 0.05 for all). Conclusion: Changes in body weight over a ten year period predicted changes in all CVD risk factors examined in women and men; whereas changes in CRF predicted changes in diastolic blood pressure and HDL.

Maternal Prenatal Weight Gain and Autism Spectrum Disorders

The rising population of individuals identified with an autism spectrum disorder (ASD) calls for further investigation of its underlying etiology. A disturbance in the fetal steroid hormone environment may be a mechanism in which environmental and genetic risk factors interact. The mother, fetus, and placenta collectively create the fetal steroid environment. Prepregnancy BMI and pregnancy weight gain have served as markers for fetal steroid hormone exposure in other disease states. This study's objective is to determine whether prepregnancy BMI and pregnancy weight gain are associated with increased ASD risk across study designs and cohorts while controlling for important confounding variables. A population-based Utah ASD cohort (n = 128) was ascertained in a 3-county surveillance area and gender- and age-matched to 10,920 control subjects. A second, research-based ASD cohort of Utah children (n = 288) and their unaffected siblings (n = 493) were ascertained through participation in an ASD genetics study. Prenatal variables were obtained from birth certificate records. ASD risk was significantly associated with pregnancy weight gain (adjusted odds ratio = 1.10, 95% confidence interval: 1.03 to 1.17; adjusted odds ratio = 1.17, 95% confidence interval: 1.01 to 1.35 for each 5 pounds of weight gained), but not prepregnancy BMI, in population and research-based cohorts, respectively. When analyses were restricted to ASD cases with normal IQ, these associations remained significant. ASD risk associated with a modest yet consistent increase in pregnancy weight gain suggests that pregnancy weight gain may serve as an important marker for autism's underlying gestational etiology. This justifies an investigation into phenomena that link pregnancy weight gain and ASD independent of prepregnancy BMI.

Metformin-induced diarrhea as delayed adverse reaction after many years of use: Case report

Background : Metformin is an oral antidiabetic drug from bigvanides group. It does not cause hypoglycemia, and therefore has found its place as a first-line therapy in type 2 diabetes. It is used both as mono-therapy and as adjunctive therapy with other anti-diabetics and insulin. Some of the most common adverse reactions of metformin are: gastrointestinal upset, diarrhea, nausea, flatulence and vomiting. Adverse reactions usually occur at the beginning of the therapy. Aim : To show the potential of metformin to cause delayed adverse effects after years of use. Case report : A sixty-four-year-old woman with type 2 diabetes was treated with metformin for ten years. Several months ago she started to have diarrhea with fluctuating character and intensity. She lost 20 pounds in weight without a special diet. Gastroenterologist and surgeon were consulted, but the cause of diarrhea was not established. A clinical pharmacologist was consulted next to evaluate possible relationship between diarrhea and medication. According to the relevant literature, metformin had the highest prevalence of diarrhea among the medication that was taken by the patient. Therefore, the strategy of discontinuation and then re-challenge by the drug was used. Two days after the metformin was discontinued the diarrhea stopped, and five days later, after the patient was re-challenged by the drug, diarrhea reappeared, with similar characteristics as before. Conclusion: Metformin-induced diarrhea usually occurs at the beginning of the treatment. However, it could have delayed appearance, even after many years of continuous use of metformin.