Prospective, Multicentre, Nationwide Clinical Data from 600 Cases of Acute Pancreatitis

OBJECTIVE: The aim of this study was to analyse the clinical characteristics of acute pancreatitis (AP) in a prospectively collected, large, multicentre cohort and to validate the major recommendations in the IAP/APA evidence-based guidelines for the management of AP. DESIGN: Eighty-six different clinical parameters were collected using an electronic clinical research form designed by the Hungarian Pancreatic Study Group. PATIENTS: 600 adult patients diagnosed with AP were prospectively enrolled from 17 Hungarian centres over a two-year period from 1 January 2013. MAIN RESULTS: With respect to aetiology, biliary and alcoholic pancreatitis represented the two most common forms of AP. The prevalence of biliary AP was higher in women, whereas alcoholic AP was more common in men. Hyperlipidaemia was a risk factor for severity, lack of serum enzyme elevation posed a risk for severe AP, and lack of abdominal pain at admission demonstrated a risk for mortality. Abdominal tenderness developed in all the patients with severe AP, while lack of abdominal tenderness was a favourable sign for mortality. Importantly, lung injury at admission was associated with mortality. With regard to laboratory parameters, white blood cell count and CRP were the two most sensitive indicators for severe AP. The most common local complication was peripancreatic fluid, whereas the most common distant organ failure in severe AP was lung injury. Deviation from the recommendations in the IAP/APA evidence-based guidelines on fluid replacement, enteral nutrition and timing of interventions increased severity and mortality. CONCLUSIONS: Analysis of a large, nationwide, prospective cohort of AP cases allowed for the identification of important determinants of severity and mortality. Evidence-based guidelines should be observed rigorously to improve outcomes in AP

The Importance of Pine Species in the Ethnomedicine of Transylvania (Romania)

The geographical and ecological features of Transylvania enable the wide ethnobotanical use of pine species. The aim of this study was to survey the current ethnomedicinal and other traditional use of pine species of Hungarian-speaking ethnic groups in Transylvania and to compare them with earlier reports performed in Transylvania and from other countries related to the Carpathian Basin. Information on pine species was obtained using semi-structured interviews with 515 Transylvanian informants from 18 villages in the period 2007–2019. The young shoots of Abies alba Mill., Picea abies (L.) H. Karst., Pinus nigra J. F. Arnold, and Pinus sylvestris L. were applied to treat respiratory diseases, while the resin was used for dental problems. Syrup and decoction were made from the cones of all species, except Abies alba. Picea abies was the most frequently documented with seven preparations from different parts (even needles), and this species was mentioned in the treatment of 21 diseases. The least recorded was Abies alba, which was applied for coughs and decayed teeth. We recorded the use of the cones and needles of Picea abies for dyspnoea, thyroid glands, and kidney disorders, previously unknown in ethnomedicinal literature. Our data on the pine species confirm their current use and significance in Transylvania

Hydrolysis of Edible Oils by Fungal Lipases: An Effective Tool to Produce Bioactive Extracts with Antioxidant and Antimicrobial Potential

Hydrolysis of olive, rapeseed, linseed, almond, peanut, grape seed and menhaden oils was performed with commercial lipases of Aspergillus niger, Rhizopus oryzae, Rhizopus niveus, Rhizomucor miehei and Candida rugosa. In chromogenic plate tests, olive, rapeseed, peanut and linseed oils degraded well even after 2 h of incubation, and the R. miehei, A. niger and R. oryzae lipases exhibited the highest overall action against the oils. Gas chromatography analysis of vegetable oils hydrolyzed by R. miehei lipase revealed about 1.1 to 38.4-fold increases in the concentrations of palmitic, stearic, oleic, linoleic and α-linolenic acids after the treatment, depending on the fatty acids and the oil. The major polyunsaturated fatty acids produced by R. miehei lipase treatment from menhaden oil were linoleic, α-linolenic, hexadecanedioic, eicosapentaenoic, docosapentaenoic and docosahexaenoic acids, with yields from 12.02 to 52.85 µg/mL reaction mixture. Folin–Ciocalteu and ferric reducing power assays demonstrated improved antioxidant capacity for most tested oils after the lipase treatment in relation to the concentrations of some fatty acids. Some lipase-treated and untreated samples of oils, at 1.25 mg/mL lipid concentration, inhibited the growth of food-contaminating bacteria. The lipid mixtures obtained can be reliable sources of extractable fatty acids with health benefits

Prolactin-releasing peptide contributes to stress-related mood disorders and inhibits sleep/mood regulatory melanin-concentrating hormone neurons in rats

Stress disorders impair sleep, quality of life, however, their pathomechanisms are unknown. Prolactin-releasing peptide (PrRP) is a stress mediator, therefore, we hypothesised that PrRP may be involved in the development of stress disorders. PrRP is produced by the medullary A1/A2 noradrenaline (NA) cells, which transmit stress signals to forebrain centers, and by non-NA cells in the hypothalamic dorsomedial nucleus. We found in male rats that both PrRP and PrRP-NA cells innervate melanin-concentrating hormone (MCH) producing neurons in the dorsolateral hypothalamus (DLH). These cells serve as a key hub for regulating sleep and affective states. Ex vivo, PrRP hyperpolarized MCH neurons and further increased the hyperpolarization caused by NA. Following sleep deprivation, intracerebroventricular PrRP injection reduced the number of REM sleep-active MCH cells. PrRP expression in the dorsomedial nucleus was up-regulated by sleep deprivation, while down-regulated by REM sleep rebound. Both in learned helplessness paradigm and after peripheral inflammation, impaired coping with sustained stress was associated with (i) overactivation of PrRP cells, (ii) PrRP protein and receptor depletion in the DLH, and (iii) dysregulation of MCH expression. Exposure to stress in PrRP insensitive period led to increased passive coping with stress. Normal PrRP signaling, therefore, seems to protect animals against stress-related disorders. PrRP signaling in the DLH is important component of the PrRP's action, which may be mediated by MCH neurons. Moreover, PrRP receptors were downregulated in the DLH of human suicidal victims. As stress-related mental disorders are the leading cause of suicide, our findings may have particular translational relevance.SIGNIFICANCE STATEMENT:Treatment resistance to monoaminergic antidepressants is a major problem. Neuropeptides that modulate the central monoaminergic signaling are promising targets for developing alternative therapeutic strategies. We found that stress-responsive prolactin-releasing peptide (PrRP) cells innervated melanin-concentrating hormone (MCH) neurons that are crucial in the regulation of sleep and mood. PrRP inhibited MCH cell activity and enhanced the inhibitory effect evoked by noradrenaline, a classic monoamine, on MCH neurons. We observed that impaired PrRP signaling led to failure in coping with chronic/repeated stress and was associated with altered MCH expression. We found alterations of the PrRP system also in suicidal human subjects. PrRP dysfunction may underlie stress disorders, and fine-tuning MCH activity by PrRP may be an important part of the mechanism

Antibiotic therapy in acute pancreatitis: From global overuse to evidence based recommendations

Background & objectives: Unwarranted administration of antibiotics in acute pancreatitis presents a global challenge. The clinical reasoning behind the misuse is poorly understood. Our aim was to investigate current clinical practices and develop recommendations that guide clinicians in prescribing antibiotic treatment in acute pancreatitis. Methods Four methods were used. 1) Systematic data collection was performed to summarize current evidence; 2) a retrospective questionnaire was developed to understand the current global clinical practice; 3) five years of prospectively collected data were analysed to identify the clinical parameters used by medical teams in the decision making process, and finally; 4) the UpToDate Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system was applied to provide evidence based recommendations for healthcare professionals. Results The systematic literature search revealed no consensus on the start of AB therapy in patients with no bacterial culture test. Retrospective data collection on 9728 patients from 22 countries indicated a wide range (31–82%) of antibiotic use frequency in AP. Analysis of 56 variables from 962 patients showed that clinicians initiate antibiotic therapy based on increased WBC and/or elevated CRP, lipase and amylase levels. The above mentioned four laboratory parameters showed no association with infection in the early phase of acute pancreatitis. Instead, procalcitonin levels proved to be a better biomarker of early infection. Patients with suspected infection because of fever had no benefit from antibiotic therapy. Conclusions The authors formulated four consensus statements to urge reduction of unjustified antibiotic treatment in acute pancreatitis and to use procalcitonin rather than WBC or CRP as biomarkers to guide decision-making

A Magyar Belgyógyász Társaság Dél-magyarországi Decentrum 43. Továbbképző Tudományos Ülésén elhangzó előadások rövid összefoglalói

1. Előszó 2. Alsó végtagi oedema ritka oka 3. Diabeteses ketoacidosis változások az utolsó öt évben 4. IGF-2-termelő prostatatumor okozta súlyos hypoglykaemia. Esetismertetés 5. Diabeteses beteg tünetmentes sokér-betegsége. Esetismertetés 6. Egy motorbaleset szövődményei – kardiológiai vonatkozások. Esetismertetés 7. Erectilis diszfunkció és alacsony tesztoszteronszint metabolikus szindróma tüneteit mutató 1-es típusú diabetesben 8. „Egyelőre idiopathiás” AA-amyloidosis. Esetismertetés 9. Anti-TNF-α-terápia mellett kialakuló lupus erythematosus 10. Pancreastumor vagy pancreatitis? 11. Videodenzitometria segítségével vizsgált myocardialis perfúzió eltérései diabetes mellitusban 12. A Clostridium difficile-fertőzések alakulása intézményünk fertőzőosztályán 2011-ig 13. A vesebetegségek felismerhetőségének aránya az eGFR tükrében vizsgálva 14. A gestatiós diabetes mellitus miatt gondozott asszonyok utánvizsgálataival szerzett tapasztalataink 15. Az aortamerevségi (stiffness) index prognosztikus jelentősége acromegaliában 16. Akut máj- és veseelégtelenség ritka oka. Esetismertetés 17. Diabeteses enteropathia, gastroparesis és neuropathia, vagy valami más? Esetismertetés 18. QT-variabilitás és vércukorszint: kimutatható-e összefüggés egészséges szénhidrát-anyagcseréjű egyénekben? 19. Renalis szimpatikus rádiófrekvenciás katéteres ablatio terápiarezisztens hypertoniában 20. A kalcium-anyagcsere útvesztői 21. Humán helminthiasisok: Az ember féregélősködők okozta bántalmainak klinikuma a gyakorlatban 22. Terápiás hatékonyság vizsgálata fokális szegmentális glomerulosclerosisos esetekben 23. Vércukormérés és csúcstechnológia 24. Metformin a terhességben. Áldás vagy átok? 25. Thrombocytopenia és immunhiány 26. Az inzulinkezeléssel járó testsúlynövekedés elkerülése intenzív inzulinanalóg-kezelési rendszerrel. Esetismertetés 27. Arteria renalis kardiogén eredetű akut thromboemboliás occlusiójának sikeres thrombolyticus kezelése. Esetismertetés 28. Microvascularis vasomotio és vércukorszint: kimutatható-e összefüggés egészséges szénhidrát-anyagcseréjű egyénekben? 29. Fődiagnózis: cardialis decompensatio. Cardialis decompensatio? Esetbemutatás 30. Tíz év tapasztalatai a gestatiós diabetes szűrésében és gondozásában 31. Az autonóm neuropathia prospektív vizsgálata inzulinpumpával kezelt 1-es típusú diabeteses betegekben 32. Vékonybél-kapszulaendoszkópiával szerzett kezdeti tapasztalataink 33. Transrectalis ultrahang (RUH) szerepe a rectum és perirectalis tér kórképeinek diagnosztikájában. Tapasztalatok saját eseteink kapcsán 34. Korszerű inzulinkezelés detemir bázisanalóggal: saját tapasztalataim és a nemzetközi obszervációs vizsgálat (A1chieve®) tükrében 35. Proteinuria mint cardiovascularis rizik