Impact of obesity on day-night differences in cardiac metabolism

An intrinsic property of the heart is an ability to rapidly and coordinately adjust flux through metabolic pathways in response to physiologic stimuli (termed metabolic flexibility). Cardiac metabolism also fluctuates across the 24-hours day, in association with diurnal sleep-wake and fasting-feeding cycles. Although loss of metabolic flexibility has been proposed to play a causal role in the pathogenesis of cardiac disease, it is currently unknown whether day-night variations in cardiac metabolism are altered during disease states. Here, we tested the hypothesis that diet-induced obesity disrupts cardiac diurnal metabolic flexibility , which is normalized by time-of-day-restricted feeding. Chronic high fat feeding (20-wk)-induced obesity in mice, abolished diurnal rhythms in whole body metabolic flexibility, and increased markers of adverse cardiac remodeling (hypertrophy, fibrosis, and steatosis). RNAseq analysis revealed that 24-hours rhythms in the cardiac transcriptome were dramatically altered during obesity; only 22% of rhythmic transcripts in control hearts were unaffected by obesity. However, day-night differences in cardiac substrate oxidation were essentially identical in control and high fat fed mice. In contrast, day-night differences in both cardiac triglyceride synthesis and lipidome were abolished during obesity. Next, a subset of obese mice (induced by 18-wks ad libitum high fat feeding) were allowed access to the high fat diet only during the 12-hours dark (active) phase, for a 2-wk period. Dark phase restricted feeding partially restored whole body metabolic flexibility, as well as day-night differences in cardiac triglyceride synthesis and lipidome. Moreover, this intervention partially reversed adverse cardiac remodeling in obese mice. Collectively, these studies reveal diurnal metabolic inflexibility of the heart during obesity specifically for nonoxidative lipid metabolism (but not for substrate oxidation), and that restricting food intake to the active period partially reverses obesity-induced cardiac lipid metabolism abnormalities and adverse remodeling of the heart

A complicated true sliding hernia presenting as a spontaneous enteroscrotal fistula in an adult

A 26-year-old man presented with an irreducible right inguino-scrotal swelling and fecal discharge from the scrotum. Exploratory laparotomy and inguinal exploration revealed that the caecum, appendix, and terminal ileum had herniated into the scrotum and had perforated through the skin forming a fecal fistula. The herniated gangrenous bowel was resected and a stoma fashioned. Spontaneous entero-scrotal fistulae are very rare and eight pediatric cases have been mentioned in literature till date. We report the first case of true sliding hernia presenting as spontaneous entero-scrotal fistula in an adult

A complicated true sliding hernia presenting as a spontaneous enteroscrotal fistula in an adult

A 26-year-old man presented with an irreducible right inguino-scrotal swelling and fecal discharge from the scrotum. Exploratory laparotomy and inguinal exploration revealed that the caecum, appendix, and terminal ileum had herniated into the scrotum and had perforated through the skin forming a fecal fistula. The herniated gangrenous bowel was resected and a stoma fashioned. Spontaneous entero-scrotal fistulae are very rare and eight pediatric cases have been mentioned in literature till date. We report the first case of true sliding hernia presenting as spontaneous entero-scrotal fistula in an adult

Superior sagittal sinus thrombosis and Budd-Chiari syndrome due to paroxysmal nocturnal hemoglobinuria managed with transjugular intrahepatic portosystemic shunt: a case report

Background: Paroxysmal nocturnal hemoglobinuria (PNH), caused by somatic mutation of hematopoietic cells, is associated with complement-mediated hemolysis and a hypercoagulable state. Thrombotic complications in this disease are associated with reduced survival. We report a patient with PNH complicated by intracranial venous thrombosis and Budd-Chiari syndrome, who was managed with transjugular intrahepatic portosystemic shunt. Case Presentation: A 26-year-old man presented with thrombosis of the superior sagittal and right sigmoid sinuses. Initial investigations did not reveal any underlying cause. Nine months later, he developed hepatic venous thrombosis. At this time, Ham test was positive. Flow cytometry confirmed the diagnosis of PNH. The patient was treated with transjugular intrahepatic portosystemic shunt; one episode of stent blockage one month later was managed successfully with balloon dilatation and restenting. Conclusion: PNH should be considered in patients with unexplained venous thrombosis. Thrombosis in these patients needs to be managed with prolonged anticoagulation. For Budd-Chiari syndrome in patients with underlying PNH, transjugular intrahepatic portosystemic shunt may be a good option but caution is needed to prevent stent occlusion

A questionnaire-based prospective study to assess professional and personal satisfaction amongst endocrine surgeons in India

Background: Endocrine surgery (ES) has been a well-recognised surgical carrier option for trainees across the globe. With the successful running of Magister Chirurgiae (MCh) training programmes at various premiere medical institutions, it is rapidly gaining popularity in India. This study was conducted to assess multiple aspects of practising endocrine surgeons in India such as financial well-being, career satisfaction, and work-life balance. Materials and Methods: A questionnaire-based survey was circulated amongst the members of the Indian Association of Endocrine Surgeons. The questionnaire included questions on various professional and personal fronts of practising endocrine surgeons in India such as training in ES, contentment/satisfaction with the field, teaching/training scenario of ES in India and comparison with opportunities outside India, rating in surgical calibre as well as choices regarding change of sector, change of speciality, etc. Results: Seventy-three endocrine surgeons participated in the study. 46.6% were ES faculties working in different medical institutes, 26% were consultants in private practice, 16.4% were ES residents training under the MCh curriculum, and 11% were general surgeons practising ES. 35.6% had less than five years of experience, 27.4% had an experience of 5–10 years and 37% had more than 10 years of experience. 79.5% said ES was their first choice. 26% had beforehand exposure to other specialities before joining ES. Academic satisfaction was found to be fulfilling in 54.8%, overall work satisfaction in 71%, surgical work satisfaction in 54.8%, financial satisfaction in 43.8%, and personal life satisfaction in 71.2%. 60.3% felt burnt out once every six months, 35.6% felt it every three months and 4.1% felt the same every month. 61.6% said that it was difficult to balance their personal and professional lives. 61.6% believed that ES training in India was better or at par compared to training outside Indian territories. 58.9% felt their surgical skill calibre was equivalent, while 27.4% claimed to be superior to their peers in other surgical specialities. 63% felt confident by the end of their training period in handling all spectrum of surgeries about ES. 82.2% had no thoughts of changing specialities, whereas 52.1% opted for a change of sector. 61.6% felt there was no gender bias in this field. Conclusion: This study is the first of its kind done among practising endocrine surgeons in India, and shows that overall surgeon satisfaction was high, wherein academic surgeons had higher career satisfaction when compared with those private practice surgeons. The quality of life of endocrine surgeons should be improved to ensure better work-life balance which can help in strengthening the cause of ES as a separate super speciality while turning the spotlight on for the younger surgeons to see

Expression of vitamin D receptor and vitamin D status in patients with oral neoplasms and effect of vitamin D supplementation on quality of life in advanced cancer treatment

Aim of the study: Vitamin D receptor (VDR) expression and serum vitamin D scores in oral premalignant lesions and oral cancer have not been widely analyzed. The role of vitamin D supplementation in advanced oral cancer for improving quality of life (QOL) is also a matter of research. Material and methods: Vitamin D receptor expression and vitamin D scores were analyzed in normal oral mucosa (n = 95), leukoplakia (n = 23) and oral cancer (n = 87). 45 patients with advanced oral cancer subjected to chemoradiation were evaluated for the effect of vitamin D supplementation on most observable QOL parameters such as oral mucositis, swallowing performance and overall QOL. Results: Vitamin D receptor expression was increased in oral neoplastic lesions. Vitamin D scores were significantly lower in cases compared to healthy controls (p = 0.002). Vitamin D supplementation significantly reduced the therapy-related toxicities in advanced cancer, thus reducing morbidity and improving QOL. Conclusions : Vitamin D receptor expression is increased in premalignant lesions and oral cancer. Vitamin D insufficiency and deficiency are prevalent in patients with oral neoplastic lesions. Vitamin D supplementation has a role in reducing treatment-related toxicities, especially in advanced cancer