Is Macronutrients Intake a Challenge for Cardiometabolic Risk in Obese Adolescents?

(1) Background: Pediatric obesity is an emerging public health issue, mainly related to western diet. A cross-sectional study was conducted to explore the association between macronutrients intake and cardiometabolic risk factors in obese adolescents. (2) Methods: Ninety-three Italian obese adolescents were recruited; anthropometric parameters, body composition, glucose and lipid metabolism profiles were measured. Macronutrients intake was estimated by a software-assisted analysis of a 120-item frequency questionnaire. The association between macronutrients and cardiometabolic risk factors was assessed by bivariate correlation, and multiple regression analysis was used to adjust for confounders such as age and sex. (3) Results: By multiple regression analysis, we found that higher energy and lower carbohydrate intakes predicted higher body mass index (BMI) z-score, p = 0.005, and higher saturated fats intake and higher age predicted higher HOmeostasis Model Assessment of insulin resistance (HOMA-IR) and lower QUantitative Insulin-sensitivity ChecK (QUICK) index, p = 0.001. In addition, a saturated fats intake <7% was associated with normal HOMA-IR, and a higher total fats intake predicted a higher HOMA of percent \u3b2-cell function (HOMA-\u3b2), p = 0.011. (4) Conclusions: Higher energy intake and lower carbohydrate dietary intake predicted higher BMI z-score after adjustment for age and sex. Higher total and saturated fats dietary intakes predicted insulin resistance, even after adjustment for confounding factors. A dietary pattern including appropriate high-quality carbohydrate and reduced saturated fat intakes could result in reduced cardiometabolic risk in obese adolescents

EUS-guided drainage using lumen apposing metal stent and percutaneous endoscopic necrosectomy as dual approach for the management of complex walled-off necrosis: a case report and a review of the literature

Background: Endoscopic ultrasound-guided drainage is suggested as the first approach in the management of symptomatic and complex walled-off pancreatic necrosis. Dual approach with percutaneous drainage could be the best choice when the necrosis is deep extended till the pelvic paracolic gutter; however, the available catheter could not be large enough to drain solid necrosis neither to perform necrosectomy, entailing a higher need for surgery. Therefore, percutaneous endoscopic necrosectomy through a large bore percutaneous self-expandable metal stent has been proposed. Case presentation: In this study, we present the case of a 61-year-old man admitted to our hospital with a history of sepsis and persistent multiorgan failure secondary to walled-off pancreatic necrosis due to acute necrotizing pancreatitis. Firstly, the patient underwent transgastric endoscopic ultrasound-guided drainage using a lumen-apposing metal stent and three sessions of direct endoscopic necrosectomy. Because of recurrence of multiorgan failure and the presence of the necrosis deeper to the pelvic paracolic gutter at computed tomography scan, we decided to perform percutaneous endoscopic necrosectomy using an esophageal self-expandable metal stent. After four sessions of necrosectomy, the collection was resolved without complications. Therefore, we perform a revision of the literature, in order to provide the state-of-art on this technique. The available data are, to date, derived by case reports and case series, which showed high rates both of technical and clinical success. However, a not negligible rate of adverse events has been reported, mainly represented by fistulas and abdominal pain. Conclusion: Dual approach, using lumen apposing metal stent and percutaneous self-expandable metal stent, is a compelling option of treatment for patients affected by symptomatic, complex walled-off pancreatic necrosis, allowing to directly remove large amounts of necrosis avoiding surgery. Percutaneous endoscopic necrosectomy seems a promising technique that could be part of the step-up-approach, before emergency surgery. However, to date, it should be reserved in referral centers, where a multidisciplinary team is disposable

Guidelines on the diagnosis, treatment and management of visceral and renal arteries aneurysms: a joint assessment by the Italian Societies of Vascular and Endovascular Surgery (SICVE) and Medical and Interventional Radiology (SIRM)

: The objective of these Guidelines is to provide recommendations for the classification, indication, treatment and management of patients suffering from aneurysmal pathology of the visceral and renal arteries. The methodology applied was the GRADE-SIGN version, and followed the instructions of the AGREE quality of reporting checklist. Clinical questions, structured according to the PICO (Population, Intervention, Comparator, Outcome) model, were formulated, and systematic literature reviews were carried out according to them. Selected articles were evaluated through specific methodological checklists. Considered Judgments were compiled for each clinical question in which the characteristics of the body of available evidence were evaluated in order to establish recommendations. Overall, 79 clinical practice recommendations were proposed. Indications for treatment and therapeutic options were discussed for each arterial district, as well as follow-up and medical management, in both candidate patients for conservative therapy and patients who underwent treatment. The recommendations provided by these guidelines simplify and improve decision-making processes and diagnostic-therapeutic pathways of patients with visceral and renal arteries aneurysms. Their widespread use is recommended

Effect of Docosahexaenoic Acid Supplementation on Microbiota in Obese ChiLdrEn : A Pilot Study (The DAMOCLE Study)

Abstract: Obesity is an inflammatory condition associated with metabolic alterations including insulin resistance. Recent researches suggested that gut microbiota plays a role in its pathogenesis. Obesity has been associated with lower bacterial diversity and higher Firmicutes/Bacteroidetes ratio (F/R ratio) compared to normal\u2010weight condition. The objective of our study was to determine the effect of 4 months algae DHA supplementation, combined with dietary and habits education, on gut microbiota composition and biochemical parameters of 12 caucasian obese children. Anthropometric measures, metabolic profile and gut microbiota analysis trough stool samples were assessed at baseline (t0), after 4 months DHA supplementation plus diet-lifestyle intervention (t1), and lastly after additional 4 months of dietary dietary-lifestyle intervention without DHA supplementation (t2). No significant improvement in dietary habits nor in metabolic profile was found after the intervention, while a significant lowering of F/R ratio was observed from t0 to t1 and even more evident at t2 control

Massive rectal bleeding treated with transcatheter artery embolization: an unusual presentation of the solitary rectal ulcer syndrome

Clinical History/Pre-treatment Imaging: A 35-year-old paraplegic man because of a thoracic spinal cord injury and, history of constipation and self-digitation maneuver to evacuate, complained rectal bleeding and maroon-colored stools from some days. Laboratory findings revealed hemoglobin of 8.3 g/dL and a hematocrit of 25% requiring the transfusion of 3 units of packed blood cells. Esophagogastroscopy was negative and colonoscopy was inconclusive showing blood and clots. Abdominal contrast enhanced CT showed endorectal active contrast extravasation from left superior hemorrhoidal artery (SHA). Endovascular angiography and embolization was performed for controlling acute bleeding. Treatment Options/Results: Selective catheter angiography at the inferior mesenteric artery demonstrated active extravasation from a peripheral posterior branch of the left SHA (Fig.1). It was subsequently super-selective embolized with coils. Post-embolization images demonstrated resolved bleeding (Fig.2). Two days later endoscopy revealed a single shallow longitudinal ulcerating lesion covered by white slough on a hyperemic surrounding mucosa. Combination of symptomatology, patient history and endoscopy prompted the diagnosis of Solitary Rectal Ulcer Syndrome (SRUS). Discussion: SRUS is a rare benign disorder supposed to be secondary to straining, self-inducted trauma, paradoxical contraction of puborectal muscle, rectal prolapse and intussusception. Although rectal bleeding is one of the most common clinical features, massive hemorrhage is extremely rare. Patients with a massively bleeding rectal ulcer that does not stabilize with endoscopic or supportive therapy must be considered for operative treatment, including endovascular embolization. Take-home points: -SRUS is an extremely rare cause of massive lower gastrointestinal bleeding. -Embolization is a safe and effective alternative to endoscopic treatment and surgery for the rapid clinical stabilization

Gastrointestinal bleeding from Dieulafoy’s lesion: endovascular management with gelfoam and coil

Clinical History/Pre-treatment Imaging: A 56-year-old man was admitted to our hospital for some day of asthenia. He reported aspirin intake for a mouth. His past medical history included splenectomy for trauma. Laboratory tests showed hemoglobin of 9.1 g/dL and digital rectal examination revealed melena. Esophagogastroduodenoscopy showed, in proximal gastric body, active arterial spurting from two close minute mucosal defect. These lesions were successfully treated with combined mechanical hemostasis and injection therapy. However, a following laboratory test revealed hemoglobin drop. Treatment Options/Results: Patient performed endovascular angiography but no active source of gastrointestinal (GI) bleeding were found. After celiac trunk catheterization, images revealed distal left gastric artery branches maintaining constant arterial caliber and tortuous appearance (Fig.1), finding suspected of Dieulafoy’s lesion. To minimize risk of premature rebleeding, embolization with gelfoam and coil was performed demonstrating reduce flow towards the proximal stomach (Fig.2). Discussion: Although often misdiagnosed, Dieulafoy’s lesion represents an important etiology of acute, life-threatening and recurrent GI bleeding. Hemostasis with angiographic embolization has been reported in sporadic case reports. To minimize the risk of bowel infarction, the super-selective catheterization technique and a temporary agent such as gelfoam slurry is mandatory. In our patient, despite active bleeding was no seen, we have decided to release also a proximal single coil. To our knowledge, it allows to reduce recurrent bleeding risk decreasing perfusion pressure but to maintain sufficient tissue blood flow avoiding ischemia. Take-home points: The embolization strategy is essential in the endovascular management of Dieulafoy’s lesion to balance the risk of rebleeding and the risk of bowel ischemia

INDICE DI ATEROGENICITA’ IN BAMBINI OBESI DOPO 1 ANNO DI INTERVENTO EDUCATIVO-NUTRIZIONALE BASATO SULLA DIETA MEDITERRANEA

Obiettivo: L’indice di aterogenicità plasmatica (AIP) riflette la relazione tra lipoproteine ad effetto protettivo e quelle aterogeniche. Lo studio intende valutare tale indice, che riflette il rischio cardiovascolare, in bambini obesi dopo 12 mesi di intervento educativo-nutrizionale. Metodi: Sono stati arruolati 125 bambini obesi di etnia caucasica. E’ stato calcolato lo z-score del BMI. Sono stati ottenuti campioni di sangue per la misurazione del profilo lipidico, dell’insulina e del glucosio, all’inizio (tempo T0) e al termine (tempo T1) dell’intervento nutrizionale. L’insulino-resistenza è stata valutata mediante l’indice HOMA-IR e l’indice TyG; la funzionalità delle cellule beta del pancreas e la sensibilità all’insulina mediante l’indice HOMA-B% e l’indice QUICKI, rispettivamente. Per il calcolo dell’AIP è stata utilizzata la seguente formula matematica: AIP= [Log(Trigliceridi/Colesterolo HDL)]. Si sono tenute sessioni educative per la promozione della dieta mediterranea associata all’attività fisica giornaliera. La significatività statistica della variazione longitudinale (T0-T1) è stata valutata mediante T-Test Per I Dati Appaiati (Wilcoxon-test). E’ stata effettuata l’analisi multivariata per l’influenza di età, sesso, stadio puberale di Tunner, valori di BMI z-score. Risultati: I bambini (n=118) a T1 hanno mostrato valori di BMI z-score più bassi rispetto a T0 [P50% dal valore di base è stata riscontrata in 38 bambini arruolati nello studio (32.2%). Conclusioni: L’AIP è stato per la prima volta considerato in uno studio pediatrico su bambini obesi ed è stata osservata una riduzione del suo valore dopo 12 mesi di intervento educativo-nutrizionale basata sui principi della dieta mediterranea