Successful treatment of visceral leishmaniasis with fluconazole and allopurinol in a patient with renal failure

Standard treatments for visceral leishmaniasis (antimonials, amphotericin B and pentamidine) pose several problems. Failure of antimonials or severe toxicity is particularly troublesome in patients with renal insufficiency. We report a case of visceral leishmaniasis and renal insufficiency successfully treated with fluconazole and allopurinol for 4 months. © 2006 Taylor & Francis

Effects of sibutramine on insulin resistance, metabolic parameters and abdominal fat mass

Objective: Obesity is recognized as a major worldwide health problem. In particular, visceral fat accumulation is usually accompanied by insulin resistance or type 2 diabetes mellitus, hypertension, hypertriglyceridemia, high uric acid and low high-density lipoprotein cholesterol levels defined as metabolic syndrome. Metabolic syndrome is strongly associated with increased risk of cardiovascular morbidity and mortality. The objective of this study was to assess the effects of sibutramine therapy on body mass index (BMI), body fat distribution, visceral fat mass (VF) accumulation, insulin resistance and plasma lipid profile in central obese patients. Material and Methods: Demographic, biochemical and anthropometric measurements, insulin resistance that was calculated by using homeostasis model assessment of 43 obese patients treated with 15 mg/day sibutramine for 6 months were evaluated. Abdominal fat distributions were determined by ultrasound examination. Results: Sibutramine treatment accompanied with life style changes (diet and exercise) demonstrated significant reductions in BMI (p< 0.0001), total body fat mass (p< 0.01), waist circumference (p< 0.0001), subcutaneous (p< 0.05) and VF (p< 0.0001), and HOMA-IR (p< 0.01). Serum total cholesterol (p< 0.05) and triglyceride (p< 0.05) levels reduced significantly after the sibutramine treatment. BMI was inversely associated with HOMA-IR. Conclusion: Sibutramine is a well-tolerated drug and may improve metabolic abnormalities in insulin resistance syndrome. In addition, it may have beneficial effects by preventing the progression of diabetes and cardiovascular diseases. Copyright © 2007 by Türkiye Klinikleri

Effect of microalbuminuria on corneal endothelium in patients with diabetes without retinopathy

Background: The aim of this study was to investigate the effect of microalbuminuria on corneal endothelium in patients with diabetes without retinopathy. Methods: This cross-sectional study comprised 100 patients with type 2 diabetes mellitus (DM) without diabetic retinopathy and 92 control subjects without diabetes. Forty-five patients had microalbuminuria and 55 subjects were microalbuminuria negative. Endothelial measurements were obtained using specular microscopy. Endothelial cell density, average area, co-efficient of variation, maximum area, minimum area, hexagonality and corneal thickness were compared between the groups on the basis of microalbuminuria, DM duration and medication, HbA1c, body mass index, serum lipid and protein profiles, hypertension and hyperlipidaemia diagnosis. Results: There were no significant differences in age, gender, endothelial cell density, average area, co-efficients of variation, maximum area, minimum area, hexagonality or corneal thickness among the microalbuminuria positive, microalbuminuria negative and control groups (p &gt; 0.05). However, microalbuminuria positive patients had lower high-density lipoprotein levels than the microalbuminuria negative patients (p = 0.042). DM and control groups showed similar endothelial measurements (p &gt; 0.05). Patients with a HbA1c &gt; 7 per cent (53 mmol/mol) had lower hexagonality value (p = 0.039) than in the subjects with a HbA1c ≤ 7 per cent. No significant differences were found in endothelial parameters when groups were compared based on DM duration, medication and co-morbidities. Conclusions: Microalbuminuria positive and negative patients with DM without retinopathy seem to have similar corneal endothelial measurements with controls. However, patients with a HbA1c &gt; 7 per cent should be monitored for deterioration in corneal endothelial cell morphology even without diabetic retinopathy, which might be critical prior to anterior segment surgery. © 2019 Optometry Australi