Preperitoneal Fat Research Articles

Long-term effects of metformin on fat depots and insulin-glucose parameters in patients with prediabetes and chronic heart failure

Introduction. Chronic heart failure with preserved ejection fraction (CHpEF) is a heterogeneous syndrome with a variety of pathophysiological factors, including obesity and impaired carbohydrate metabolism associated with an increase in visceral adipose tissue. Due to the positive effect of metformin on weight loss, in recent years special attention has been paid to its effect on fat depots.Aim. To study the effects of metformin XR after 12 months of administration on various fat depots and glucose metabolism parameters in patients with CHpEF, prediabetes and abdominal obesity (AO).Materials and methods. A single-center open-label randomized prospective controlled trial included 64 people (50% men, median age 58 [55.25; 59.75] years) with CHpEF, prediabetes and AO. All patients (groups A and B) received optimal CHpEF therapy. In group A (n = 32), metformin XR 1000–1500 mg/day was additionally prescribed. All patients underwent general clinical examination, calculation of insulin resistance indices, ultrasound lipometry with determination of the size of epicardial, preperitoneal and subcutaneous fat, in addition, the thickness of epicardial fat was assessed using magnetic resonance imaging (MRI) of the heart.Results. In group A, after 12 months of the study, fasting plasma glucose levels decreased from baseline by 7.7% (p < 0.0001), glycated hemoglobin by 3.3% (p = 0.008), fasting insulin by 20% (p = 0.004) and HOMA-IR and FIRI indices by 25.3% (p = 0.001). In the control group, on the contrary, the values of glycated hemoglobin increased by 3.4% (p = 0.021), fasting insulin by 45% (p = 0.031), HOMA-IR and FIRI by 52.4% (p = 0.020). In group A, the thickness of epicardial fat decreased by 6.1% (p = 0.020) according to ultrasound and MRI lipometry by 16.7% (p = 0.029), preperitoneal fat by 3.0% (p = 0.009), subcutaneous fat by 11.2% (p = 0.001).Conclusion. Metformin XR therapy for 12 months in patients with prediabetes, CHpEF and AO against the background of optimal basic CHpEF therapy had a beneficial effect on glucose metabolism (decrease in fasting plasma glucose and insulin, glycated hemoglobin, insulin resistance indices HOMA-IR, FIRI) and on subcutaneous and visceral adipose tissue depots: epicardial and preperitoneal.

Strong association between sarcopenia and visceral fat in the long term after cholecystectomy: A cross-sectional study using the ISarcoPRM algorithm.

Cholecystectomy generally has no adverse effects on health. Studies demonstrating the association between metabolic diseases and long-term effects of cholecystectomy are increasing. preperitoneal fat thickness (PFT) is an important indicator of metabolic syndrome. Metabolic syndrome is a risk factor for sarcopenia. The aim of our study was to investigate the relationship between cholecystectomy and sarcopenia-visceral fat using the ISarcoPRM algorithm, which is an easy, reliable, and inexpensive method based on ultrasound measurement, to evaluate sarcopenia in patients with long-term previous cholecystectomy. This cross-sectional study included participants who had undergone cholecystectomy at least 5 years ago and a control group with similar characteristics. Sarcopenia was assessed using the ISarcoPRM algorithm, incorporating the sonographic thigh adjustment ratio (STAR), grip strength, and chair stand test (CST). Together with low STAR values (<1.0 for females and <1.4 for males), ow grip strength (<19 kg for females or <32 kg for males), and/or prolonged CST duration (≥12 seconds) were used to diagnose sarcopenia. Ultrasound was used to measure the visceral fat thickness. The investigation of sarcopenia and PFT values between individuals with and without cholecystectomy was planned. A total of 158 participants were included, including 89 post-cholecystectomy patients and 69 controls. Binary regression analysis revealed that cholecystectomy was positively associated with sarcopenia (OR = 2.788, 95% CI: 1.054-7.375, P = .039). However, when PFT was included, it was independently associated with sarcopenia (OR = 1.157, 95% CI: 1.067-1.254, P < .001), and the relationship with cholecystectomy disappeared (P > .05). PFT values of 10.0 mm or higher were associated with 5.875 times (95% CI: 2.035-16.961, P = .001) increased odds of sarcopenia. Sarcopenia was 2.8 times more frequent in patients who had undergone cholecystectomy than in those who had not, but this relationship was mediated by increased PFT. The risk of sarcopenia increased up to 5.875 times when the PFT exceeded 10 mm.

Spigelian hernias in the adult population: a systematic review of the literature.

Spigelian Hernia (SH) is characterized by the protrusion of abdominal viscera or preperitoneal fat through a defect in the spigelian aponeurosis. The objective of this systematic review was to evaluate current literature on Spigelian Hernias in adult population and elucidate their characteristics and preferable management. MEDLINE and Scopus bibliographical databases were systematically searched (last search: 31st January 2024) for studies concerning SHs. Two hundred and thirty-four articles met predefined inclusion criteria and concerned collectively 1,629 patients with SHs (58.7% females) with an age of 62.32 ± 17.71 (mean ± SD) years and a BMI of 28.56 ± 7.34 (mean ± SD) kg/m2. A minimally invasive approach was opted at 46.8% of cases, while a mesh was implemented at 67.9% of cases. Postoperative length of hospital stay was 2.8 ± 2.9 (mean ± SD) days. Following individual cases analysis, open surgery was preferable at emergency setting (OR: 2.45; 95% CI: 1.36-4.41; p-value: 0.003), and minimally invasive approaches were associated with shorter length of hospital stay [2 (1-9) vs. 5 (1-22) days; p-value: <0.001]. Overall, thirty-day postoperative morbidity and mortality rates reached 7.0% and 0.3% respectively. SH is a rare ventral hernia, and it concerns most frequently overweight women. Open surgical approach is preferred in emergency cases, while laparoscopic surgery is associated with shorter hospitalization. Further comparative studies are necessary to determine optimal surgical approach.

Incarcereted Epigastric Hernia with Liver Content: a Case Report

The epigastric hernia sac usually contains preperitoneal fat tissue, omentum, and intestines, but the presence of liver tissue is extremely rare. Epigastric hernia is a type of hernia in the midline of the abdominal wall between the umbilicus and the xiphoid process. It may be asymptomatic in some patients and cause complaints such as pain and nausea in most patients, but serious complications such as incarceration and strangulation are rare. In the present case, a 74-year-old woman was examined and found to have an irreduced omentum, transverse colon and liver tissue inside the hernia sac. She underwent an open procedure with onlay mesh-assisted hernia repair. Rare but serious complications, such as liver tissue incarceration, should be considered in epigastric hernia patients.

LAPAROSCOPIC TREATMENT OF RIGHT INGUINAL HERNIA RE-RECURRENCE

Abstract We report the case of an 81-year-old man presenting with a right inguinal hernia re-recurrence. He had undergone a laparoscopic transabdominal preperitoneal hernioplasty in 2001. The recurrence occurred in 2021, and therefore, he had to be treated with an open approach. Past medical history included arterial hypertension, COPD, coronary artery stenting for ischemic heart disease, stage II chronic renal failure. Previous surgeries consisted of bilateral iliac arteries, percutaneous angioplasty and stenting with a right femoral arterial access, laminectomy of L3–L5, and laparoscopic cholecystectomy. Surgical procedure Laparoscopy confirmed a right hernia re-recurrence. Herniated ileal loop was completely reduced. Peritoneal incision was performed with a lateral-to-medial approach. The mesh was dissected away from the pre-peritoneal fat. The shrunk mesh was pulled downwards to allow the identification of the epigastric vessels, which were then dissected according to a cranial-to-caudal approach. The large hernia sac was completely reduced thus exposing the re-recurrence orifice. Dissection was carried out towards the Bogros’ space. Epigastric vessels were detached from the mesh thus allowing to expose the medial part of the myopectineal orifice. Cooper’s ligament and pubic symphysis were therefore identified. The epigastric and spermatic vessels were freed from the mesh only after the critical view of the myopectineal orifice (MPO) was achieved. The mesh was completely mobilized from the peritoneum and removed. A “landing zone” was obtained, a 15 × 10 cm self-fixating mesh positioned around the re-recurrence orifice. Peritoneum closure was performed by means of a 3–0 running barbed suture from medial to lateral.

Differences in the Evaluation of Malnutrition and Body Composition Using Bioelectrical Impedance Analysis, Nutritional Ultrasound, and Dual-Energy X-ray Absorptiometry in Patients with Heart Failure.

Although malnutrition is frequently observed in patients with heart failure (HF), this diagnosis should be performed carefully since HF itself is associated with increased inflammatory activity, which affects body weight, functionality, and some nutritional parameters; thus, its isolated interpretation can erroneously identify surrogate markers of severity as markers of malnutrition. In this context, we aimed to evaluate the prevalence of malnutrition using different classification systems and perform a comprehensive nutritional evaluation to determine the reliability of different diagnostic techniques. Eighty-three patients with a recent hospital admission due to HF were evaluated. GLIM diagnosis criteria and subjective global assessment (SGA) were performed; a comprehensive anthropometric, functional, and biochemical nutritional evaluation was performed, in which bioelectrical impedance analysis (BIA), nutritional ultrasound, and dual-energy X-ray absorptiometry (DXA) were performed. Additionally, mortality and additional admissions due to HF were determined after a mean follow up of 18 months. Malnutrition according to the GLIM criteria (54%) accurately distinguished patients with impaired functionality, lower lean mass, skeletal mass index, and appendicular muscle mass (BIA), as well as lower trunk fat mass, trunk lean mass, fat-free mass (DXA), and decreased albumin and increased C-reactive protein serum levels. According to SGA, there were significant changes in body composition parameters determined by BIA, muscle ultrasound, and functional tests between well-nourished patients and patients with risk of malnutrition (53.7%) or who had malnutrition (7.1%), but not when the last two groups were compared. BIA and DXA showed strong correlations when evaluating muscle and fat mass in HF patients, but correlations with nutritional ultrasound were limited, as well as functional tests. A multivariate analysis showed that no significant association was observed between body composition and mortality, but preperitoneal fat was associated with an increased risk of new hospital admissions (OR: 0.73). GLIM criteria identified a lower percentage of patients with HF and malnutrition compared with SGA; thus, SGA could have a role in preventing malnutrition in HF patients. Nutritional evaluation with BIA and DXA in patients with HF showed reliable results of body composition parameters in HF, and both help with the diagnosis of malnutrition according to the GLIM or SGA criteria and could provide complementary information in some specific cases.

Ligamentum teres hepatis incarcerated within linea alba hernia: A case report

Abstract Incarcerated linea alba hernia is a rare form of ventral hernia. Most of these contain pre-peritoneal fat or the omentum. Herniation of containing ligamentum teres hepatis is seldom seen. A 52-year-old man presented with an abdominal wall mass and dull pain for 2 weeks. Computed tomography and ultrasound examination of the abdomen revealed an epigastrium linea alba hernia containing the liver round ligament. A hernial sac of size 3 cm × 4 cm was explored by laparoscopic surgery and successfully managed with hernia repair.

Inguinal Hernia Repair Using the External Oblique Muscle Fascia: Desarda Technique

&amp;lt;i&amp;gt;Introduction&amp;lt;/i&amp;gt;: An inguinal hernia is a protrusion of abdominal cavity contents or pre-peritoneal fat through a hernial defect in the inguinal region. Desarda&amp;apos;s technique is an aponeuroplasty, based on closure of the posterior wall of the inguinal canal by a flap of the external oblique fascia. This technique has the advantage over prosthetic cures in that it is a tension-free cure and does not require an implant. The aim of this study is to demonstrate the feasibility of curing inguinal hernias using the Desarda technique, and to evaluate the initial results in our practice. &amp;lt;i&amp;gt;Material And Method&amp;lt;/i&amp;gt;: This is a prospective study over a 2-year period (January 2017 - December 2018), covering 100 cases of uncomplicated inguinal hernia cure in 98 patients operated on by aponeurotic plasty (Desarda technique), in the general surgery department of Ignace DEEN Hospital. Selection criteria were: informed consent, age over 15 years, uncomplicated primary inguinal hernias, normal prostate ultrasound and PSA results for adult males over 50 years of age. &amp;lt;i&amp;gt;Results&amp;lt;/i&amp;gt;: The study included 100 cases of uncomplicated inguinal hernia repair in 94 patients operated on by aponeurotic plasty (Desarda technique). The patients were 88 men (94%) and 6 women (6%), with a mean age of 44.7 years and extremes of 19 and 78 years. The majority of patients (37 or 39.36%) were blue-collar workers. The hernia was unilateral in 88 patients and bilateral in 6. One woman had a bilateral hernia. The hernia was located only on the right in 72 cases and only on the left in 20. According to the Nyhus classification, type IIIb 45% was the most frequent. The patients were operated on under spinal anesthesia in 68 cases. On the first postoperative day, nine patients (9.57%) were assessed as having moderate pain. Beyond the third month, pain assessment revealed five cases of chronic pain. Surgical site infection was the most frequent complication. With an average follow-up of 17 months, no cases of recurrence were noted.

Robotic transabdominal preperitoneal repair for bilateral obturator hernia: a video vignette.

Obturator hernias (OHs) are a rare cause of bowel obstruction that requires immediate surgical intervention to prevent morbidity and mortality. Patients with OHs present with acute intestinal obstruction secondary to incarceration, with a high morbidity and mortality rate due to delayed diagnosis and treatment. Although several surgical approaches have been reported, a standard approach for OH treatment has not yet been established. Here, we report the case of a 74-year-old woman who presented with bilateral OHs. The patient presented at our institution with pain in the left lower quadrant. Computed tomography revealed preperitoneal fat in both obturator foramen. Robotic transabdominal preperitoneal (R-TAPP) bilateral OH repair was performed, and a mesh was placed over both obturator foramen. The patient recovered without postoperative complications and was discharged on postoperative day 2. This suggests that the R-TAPP approach is safe for OH repair without incarceration.

Patient Profile of Primary Peritonitis, Secondary Peritonitis, and Tertiary Peritonitis

Background: Peritonitis is an inflammation that occurs in the peritoneum. The complex structure of the abdomen makes diagnosing and treating intraperitoneal infections challenging in the practice of medicine. Purpose: This study aims to determine the profile of primary peritonitis, secondary peritonitis, and tertiary peritonit patients treated at RSUP Prof. Dr. R. D. Kandou Manado in 2022. Methods: This study used a retrospective descriptive method using medical record data of peritonitis patients during the period January – December 2022. Result : Peritonitis patients are treated at RSUP. Prof. Dr. R. D. Kandou Manado most often occurs in men. Generally occurs in the age group of 19-59 years. Based on the etiology, Hepatic cirrhosis (45%) is the most common etiology of primary peritonitis, gastric perforation (38%) is the most common etiology of secondary peritonitis, post appendectomy (18%), post nephrostomy (18%) and leakage sigmoid anastomosis (18%) is the most common etiology of tertiary peritonitis. Generally patients have radiological features of preperitoneal fat depletion (44%), and subdiaphragm free air (20%). Most patients receive operative treatment. Most patients present with sepsis. Conclusion: Peritonitis is most common in males, age group 19-59 years, most primary peritonitis is caused by hepatic cirrhosis, most secondary peritonitis is caused by gastric perforation, and most tertiary peritonitis is caused by post appendectomy, post nephrostomy and leakage sigmoid anastomosis. Most patients present with depletion of preperitonela fat, subdiaphragmatic free air, receive operative treatment, and present with sepsis. &#x0D; Keywords: profile; primary peritonitis; secondary peritonitis; tertiary peritonitis.

Revisiting the predictability of follicular fluid leptin and related adiposity measures for live birth in women scheduled for ICSI cycles: a prospective cohort study

BackgroundOur research question is could follicular fluid (FF) leptin solely or contemporaneously with other clinical, biochemical, and sonographic adiposity measures predict the probability of having a live birth during ICSI cycles? This is a prospective cohort study that enrolled infertile women without polycystic ovary syndrome scheduled for ICSI. At baseline, women had an assessment of obesity using different metrics: clinical, serum biochemical, and sonographic. Clinical measures encompassed waist circumference and body mass index. Biochemical evaluation comprised an assessment of the homeostasis model for insulin resistance, visceral adiposity index, and lipid accumulation product. Preperitoneal and subcutaneous abdominal fat were measured using ultrasound and body fat index was calculated. On the day of oocyte retrieval, pooled FF was sampled to assess FF leptin. Our primary outcome was live birth after one fresh embryo transfer cycle.ResultsOut of 91 women analyzed in this study, 28 have a live birth (30.8%). No difference in FF leptin concentration was found between women with and without live birth (mean ± SD; 20336 ± 8006 vs 18493 ± 6655 pg/ml; P = 0.2). None of the assessed adiposity markers was a predictor for live birth. Substantially, follicular fluid leptin was positively correlated with insulin resistance in women with and without live birth (r = 0.21, P = 0.04). In logistic regression analysis, the outcome of the prior cycle, the ability to have cryopreserved embryos, and the oocyte maturation index were the predictors for live birth in our study.ConclusionsThe present work could not find evidence that follicular fluid leptin, preperitoneal fat, and other evaluated adiposity measures could impact live births after ICSI cycles.

Pre-peritoneal Fat as a Guide to Extended View Total Extraperitoneal (eTEP) Repair for Inguinal Hernia.

In the extra-peritoneal approach for inguinal hernias, pre-peritoneal space creation is one of the most crucial steps. In the absence of well-defined landmarks, it is difficult to identify the correct plane of dissection, and blind dissection can sometimes lead to peritoneal injury, resulting in loss of working space. In this article, we describe our technique of pre-peritoneal space creation by following the fatty tissue of the median umbilical ligament and fatty tissue along the rectus muscle. The data of all patients (total 84) who underwent surgery with this technique between January 2021 and May 2023 were retrieved and assessed for demographics, hernia type, and perioperative complications. Except for two peritoneal injuries, there were no other intraoperative complications.

Effect of Liraglutide in Different Abdominal Fat Layers Measured by Ultrasound: The Importance of Perirenal Fat Reduction

Introduction: Ultrasonography (US) in patients with obesity allows us to measure different layers of abdominal fat (superficial subcutaneous, deep subcutaneous, preperitoneal, omental, and perirenal), not assessable by DEXA or CT scan. Omental and perirenal fat depots are considered predictors of metabolic complications. Liraglutide is particularly effective in reducing weight in patients with insulin-resistance, but its direct impact on each abdominal fat layer is unknown. Methods: We measured, at the L4 level, all 5 abdominal fat depots in 860 patients with obesity (72.8% women, mean age 56.6 ± 1.5 years, BMI 34.4 ± 4.7 kg/m2, body fat 47 ± 2%, abdominal circumference 105.8 ± 3 cm), before and after 6 months of liraglutide treatment. Laboratory tests for glucose, insulin, and lipid profile were routinely done. T-student was used to compare intraindividual differences. Results: Weight loss was 7.5 ± 2.8 kg (7.96% from baseline), with no differences by sex/age/BMI. Greater loss was observed in patients with higher dosages and NAFLD. All US-measured fat layers showed a significant reduction (p < 0.05) at 6th months. Preperitoneal fat showed a −26 ± 5.5% reduction and 46% of the patients went below metabolic syndrome (MS) risk cut-off values. Omental fat was reduced by −17.8 ± 5% (67% of the patients below MS risk) and perirenal fat by −22.4 ± 4.4% (56% of the patients below MS). Both omental and perirenal fat reduction correlated with total and LDL cholesterol. Higher perirenal fat reduction (−28%) was seen among patients with obesity and hypertension. Perirenal fat also correlated with blood pressure reduction. Conclusion: Liraglutide induces greater fat loss in the layers involved with MS. However, the maximal reduction is seen at perirenal fat, which has been recently related with hypertension and could play an important role in modulating kidney’s expansion and intraglomerular pressure. US is a reproducible clinical tool to assess pathologic fat depots in patients living with obesity.

FEATURES OF THE LIPID PROFILE AND ADIPOSE TISSUE IN PATIENTS WITH CAROTID ARTERY STENOSIS ON THE BACKGROUND OF CORONARY ARTERY DISEASE

HighlightsIntra-abdominal adipose tissue thickness (IAAT) was statistically significantly greater in patients with hypertriglyceridemia compared to patients with normal triglyceride levels. Linear regression analysis confirmed the following findings: the greater the thickness of IAAT and preperitoneal fat thickness (PFT), the higher the levels of triglycerides and very-low-density lipoproteins.AbstractAim. To assess the lipid profile and distribution of adipose tissue (based on ultrasound parameters) and their role in the development of carotid artery stenosis in patients with coronary heart disease (CHD).Methods. Ultrasound parameters of adipose tissue in 125 patients, diagnosed with coronary heart disease (CHD), were studied. The average age of the patients was 68 (61.0; 74.0) years old. The sample was represented predominantly by males (58.4%).Results. It was determined that in patients who did not reach the target levels of triglycerides (TG), the thickness of the IAAT is 15 mm more than in patients with the adequate level of this indicator (p = 0.031). Subcutaneous adipose tissue (SAT) values also exceeded the values ​​in individuals with low HDL levels (p = 0.050), in contrast to patients with normal HDL. Linear regression analysis (after adjusting for gender and age) showed that the increase in IAAT thickness was associated with the increase in TG (b = 0.002, p = 0.028) and VLDL (b = 0.001, p = 0.023). It was also found that only 43.4% of the examined individuals received lipid-lowering therapy, and 17.3% received an adequate dose of statins (reached the target LDL values).Conclusion. No statistically significant patterns were found between the achievement of lipid targets and the presence of carotid stenosis. An extremely low percentage of patients taking adequate lipid-lowering therapy (17.3%) was determined, and the proportion of the people with carotid stenosis who reached the target levels of total cholesterol was 58.4%, TG – 79.3%, HDL – 31.7%, LDL – 12.2%. The thickness of the IAAT is statistically significantly higher in individuals with hypertriglyceridemia, in contrast to patients with normal TG levels. The tendencies towards statistical significance of PFT indicators in individuals with hypertriglyceridemia, minimum and maximum SAT values, depending on the level of HDL, were determined. Linear regression analysis confirmed the data obtained: the higher the thickness of IAAT and PFT, the higher the levels of TG and VLDL.

Changes in preperitoneal fat measured by nutritional echography after 6 month multidimensional follow-up in patients after admission to the intensive care unit for severe covid-19 pneumonia, as a function of the presence of previous diabetes mellitus

Changes in preperitoneal fat measured by nutritional echography after 6 month multidimensional follow-up in patients after admission to the intensive care unit for severe covid-19 pneumonia, as a function of the presence of previous diabetes mellitus

Changes in mesenteric fat thickness and its clinical impact in bariatric surgery.

Obesity, especially central obesity is associated with increased risk of metabolic syndrome, non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus. The study aimed to investigate the associations of the changes of abdominal fat thicknesses with changes of anthropometric indexes and improvements of metabolic phenotypes in patients with obesity and T2DM before and after bariatric surgery. Between April 2016 and January 2017, 34 adult patients with concurrent obesity and T2DM scheduled for different bariatric surgeries were prospectively evaluated by ultrasound before and 1-year after bariatric surgery to determine abdominal fat thicknesses (mesenteric fat, preperitoneal fat and subcutaneous fat) and NAFLD. At 1 year, of the 25 patients that finished the study, significant decrease in mesenteric-fat-thickness was associated with significant reduction of obesity, that is, BMI (-24%, p < .001), remission of metabolic syndrome (32%, p = .008), NAFLD (60%, p < .001) and T2DM (44%, p < .001). Lower baseline mesenteric fat thickness was associated with remission of metabolic syndrome. Lower baseline mesenteric-fat-thickness may have the potential to predict metabolic syndrome remission after bariatric surgery.

Use of ECO-fast at obesity children as a tool for detecting risk of non-alcoholic fatty liver disease

Introduction and objectives: In recent decades, a significant increase in childhood obesity has been observed. For this reason, it is interesting to have early markers of comorbidi-ty. Ultrasound of adipose and muscle tissue is an emerging technique validated in adults, with no studies in the pediatric population. The main objective of this study is to assess whether the measurement of preperitoneal fat by nutritional ultrasound is a good screening method for non-alcoholic fatty liver disease (NAFLD) in obese children. Patients and methods: Prospective longitudinal study. A study of somatometry, bioelectrical impedancemetry and nutritional ul-trasound has been carried out. Results: 102 patients were included, with a mean BMI (SDS) of 2.58. A linear and direct correlation was observed between the fat mass measured by bioelectri-cal impedancemetry and the total subcutaneous abdominal fat measured by nutritional ultra-sound. We also observed a correlation between preperitoneal fat measured by nutritional ultra-sound and NASH, with a cut-off point of 0.93 cm of preperitoneal fat (sensitivity 96% and speci-ficity 94%). Conclusion: Measurement of preperitoneal fat by nutritional ultrasound is a good screening method for NASH in obese children.

The Level of Inflammatory Markers and Their Relationship with Fat Tissue Distribution in Children with Obesity and Type 2 Diabetes Mellitus.

This study aimed to determine the changes in proinflammatory and anti-inflam- matory markers in children aged 10-18, who were not diagnosed with type 2 diabetes mel- litus, were obese/overweight, and children with type 2 diabetes mellitus. In addition, we aimed to investigate whether these markers were associated with clinical and laboratory parame- ters, subcutaneous adipose tissue, preperitoneal adipose tissue, visceral adipose tissue, and hepatosteatosis. Children between the ages of 10 and 18, obese/overweight, with type 2 diabetes mellitus, and with a normal body mass index were included. Fat tissue thick- ness was measured. Tumor necrosis factor-α, interleukin-1β, interleukin-6, interleukin-18, and interferon-γ as proinflammatory markers and transforming growth factor-β and interleukin-10 levels as anti-inflammatory markers were studied. Twenty-eight (31.8%) controls, 44 (50%) obese/overweight, and 16 (18.2%) patients with type 2 diabetes mellitus were included in our study. Age, sex, and puberty were similar between the groups. In the type 2 diabetes mellitus group, the subcutaneous fat tissue thick- ness was higher than that in the obese group, and the preperitoneal and visceral fat tissue thicknesses were similar to those in the obese group. Proinflammatory markers and interleu- kin-10 levels were similar in the obese/overweight, type 2 diabetes mellitus, and control groups. Transforming growth factor-β levels were significantly lower in the type 2 diabetes mellitus group than in the control group (P = .039). Transforming growth factor-β levels and other labo- ratory variables did not differ significantly in the type 2 diabetes mellitus group. While there was no change in all markers in the obese/overweight group com- pared with the control group, proinflammatory markers in the type 2 diabetes mellitus group were similar to those in the obese/overweight and control groups, and transforming growth factor-β level, an anti-inflammatory marker, was lower in the type 2 diabetes mellitus group than in the control group.

Femoral Hernia Presenting as Richter’s Variant: A Rare Case Report

Background: Richter's hernia occurs when a portion of the anti-mesenteric border of a bowel wall is captured within the hernia sac, resulting in ischaemia, gangrene, and perforation. Only part of the circumference of the bowel wall is involved in Richter's hernia, which causes strangulation without obstruction. Femoral hernia presenting as a Richter’s hernia is rare. Aim: This is to report a case of Richter’s hernia in a femoral hernia occurring in an adult female. Case Report: In this case, a 62-year-old woman presented with a history of sudden generalized abdominal pain. Before the presentation, she had a six-year history of reducible left inguino-labial swelling that became irreducible two weeks ago. Pallor was present. Her temperature was 39.2°C, her pulse rate was 112 per minute, and her blood pressure was 132/62 mmHg. A diagnosis of a left femoral hernia was made. She was revived, and the groin swelling was explored through a midline incision over the abdomen. There was ischaemia of the anti-mesenteric border of the ileum, along with strangulated preperitoneal fat. The bowel vascularity over the anti-mesenteric border was doubtful, so a resection anastomosis of the segment of the bowel was done followed by a reduction of the bowel loop and herniorraphy. Conclusion: It is rare for a femoral hernia to present with a Richter's hernia, but it can happen even in the absence of obstructive symptoms. Any time there is groin swelling, it is important to get a quick, correct diagnosis and treatment. If there is a delay in identification and treatment, a spontaneous faecal fistula, an uncommon complication, may develop. The relevant authorities must address this as it reflects the status of healthcare in the developing world.

Ultrasonographic Assessment of Body Fat Index for Prediction of Gestational Diabetes Mellitus and Neonatal Complications

ObjectivesTo assess maternal pre-peritoneal fat and subcutaneous fat at 16–20 weeks gestation by ultrasound. Thus, calculate body fat index (BFI) and determine its cut-off value for prediction of gestational diabetes mellitus (GDM) and neonatal subcutaneous adiposity. MethodsA cohort study was conducted in 200 pregnant women with singleton fetus during anomaly scan using BFI where they were screened for GDM at 24–28 weeks gestation by oral glucose tolerance test. Labour and neonatal outcomes were recorded. The receiver operating characteristic curve was used to determine the cut-offs for BFI, pre-peritoneal fat thickness, and subcutaneous fat thickness in order to predict GDM. ResultsThe area under receiver operating characteristic curve for BFI was 0.967 (95% CI 0.932–0.987) with a sensitivity of 97.3%, specificity of 89.57%, negative predictive value of 99.3%, and diagnostic accuracy of 91% at a BFI cut-off of 0.88. The study analysis demonstrated BFI to be statistically superior to BMI > 22.9 kg/m2 for prediction of GDM. BFI > 0.88 was a risk factor for developing neonatal subcutaneous adiposity. ConclusionsBFI is a practical and convenient non-invasive screening tool to predict GDM and neonatal subcutaneous adiposity.