ro13-9904 and Weight-Loss

Pregnancy is one of the risk factors for biliary sludge (BS) formation. In this cross-sectional study, a total of 959 pregnant women were included. Serum aspartate aminotransferase, alanine aminotransferase, sodium, potassium, triglycerides, cholesterol levels and the presence of ketones in urine were determined. The presence of BS was investigated using maternal abdominal ultrasound. The incidence of BS in pregnancies complicated by hyperemesis gravidarum (HG) was 14%. The degree of ketonuria and low birth weight were statistically higher in pregnancies with maternal BS than women without sludge. Total weight gain during pregnancies with BS was statistically lower than controls. The incidence of BS in pregnancies with HG does not appear to increase due to HG-related complications, such as dehydration, starvation and weight loss. However, the severity of HG may be worse when HG is associated with sludge.Impact Statement

Topics: Alanine Transaminase; Aspartate Aminotransferases; Bile; Ceftriaxone; Cholesterol; Cross-Sectional Studies; Female; Humans; Hyperemesis Gravidarum; Incidence; Infant, Newborn; Ketones; Lipids; Potassium; Pregnancy; Pregnancy Trimester, First; Sewage; Sodium; Triglycerides; Weight Loss

Topics: Anti-Bacterial Agents; Arthritis; Ceftriaxone; Diagnosis, Differential; Diarrhea; Duodenum; Endoscopy, Digestive System; Fever; Humans; Male; Middle Aged; Tropheryma; Weight Loss; Whipple Disease

The aim of this study was to test whether the perioperative composition of intestinal microbiota can contribute to variable outcomes following vertical sleeve gastrectomy (VSG).. Although bariatric surgery is the most effective treatment for obesity, metabolic outcomes are variable.. Diet-induced obese mice were randomized to VSG or sham surgery, with or without exposure to antibiotics that selectively suppress mainly gram-positive (fidaxomicin, streptomycin) or gram-negative (ceftriaxone) bacteria on postoperative days (POD) 1-4. Fecal microbiota was characterized before surgery and on POD 7 and 28. Mice were metabolically characterized on POD 30-32 and euthanized on POD 35.. VSG resulted in weight loss and shifts in the intestinal microbiota composition relative to sham-operated mice. Antibiotic exposure resulted in sustained reductions in alpha (within-sample) diversity of microbiota and shifts in its composition. All antibiotic treatments proved to be detrimental to metabolic VSG outcomes, regardless of antimicrobial specificity of antibiotics. These effects involved functionally distinct pathways. Specifically, fidaxomicin and streptomycin markedly altered hepatic bile acid signaling and lipid metabolism, while ceftriaxone resulted in greater reduction of key antimicrobial peptides. However, VSG mice exposed to antibiotics, regardless of their specificity, had significantly increased subcutaneous adiposity and impaired glucose homeostasis without changes in food intake relative to control VSG mice.. Dysbiosis induced by brief perioperative antibiotic exposure attenuates weight loss and metabolic improvement following VSG. Potential mechanisms include disruption of bile acid homeostasis and reduction in the production of gut antimicrobial peptides. Results of this study implicate the intestinal microbiota as an important contributor to metabolic homeostasis and a potentially modifiable target influencing clinical outcomes following VSG.

Topics: Animals; Anti-Bacterial Agents; Ceftriaxone; Disease Models, Animal; Fidaxomicin; Gastrectomy; Gastrointestinal Microbiome; Male; Mice; Mice, Inbred C57BL; Obesity; Streptomycin; Treatment Failure; Weight Loss

Topics: Ceftriaxone; Diagnosis, Differential; Female; Humans; Middle Aged; Nephrectomy; Pyelonephritis, Xanthogranulomatous; Weight Loss

Whipple's disease is a rare chronic multi-systemic infection, caused by Gram-positive bacillus Tropheryma whipplei. The infection usually involves the small bowel, but other organs may also be involved. The diagnosis is often challenging and can only be made on histopathological examination. This report describes 2 patients presenting with abdominal pain and weight loss who finally were diagnosed to have Whipple's disease. One of the patients was a renal transplant recipient. To the best of authors' knowledge, no case of Whipple's disease has yet been reported in Pakistan. The diagnosis were made on the basis of histopathological evaluation of duodenal biopsies. The cases underscore the need for diligent histopathological evaluation of the upper gastrointestinal biopsies and a high index of suspicion for an accurate diagnosis of the condition. The approach to the diagnosis and management of the condition is discussed.

Topics: Abdominal Pain; Adult; Anti-Bacterial Agents; Biopsy; Ceftriaxone; Female; Humans; Intestine, Small; Male; Pakistan; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Tropheryma; Weight Loss; Whipple Disease

A young man presented with recent-onset non-specific symptoms like headache, sleepiness and weight loss, interfering with normal daily life. Physical and biochemical irregularities were absent. Because extensive examination by neurologist and psychiatrist including brain imaging did not reveal any clues, the complaints were initially considered psychosomatic. As the symptoms deteriorated with ongoing weight loss, the patient was re-admitted to the hospital. Again, extensive additional investigation did not reveal any abnormalities. Because of previous exposition to the woods Lyme serology was determined. Surprisingly, it appeared to be a remarkable presentation of acute Lyme neuroborreliosis which was successfully treated with ceftriaxon. Clinicians must be aware of the fact that this severe illness can present without any typical symptoms.

Topics: Adult; Anti-Bacterial Agents; Antibodies, Bacterial; Borrelia burgdorferi; Ceftriaxone; Diagnosis, Differential; Dizziness; Headache; Humans; Lyme Neuroborreliosis; Male; Medical History Taking; Neck Pain; Photosensitivity Disorders; Weight Loss

Topics: Adult; Anti-Bacterial Agents; Biopsy; Capsule Endoscopy; Ceftriaxone; Colonoscopy; Diarrhea; Humans; Male; Periodic Acid-Schiff Reaction; Rare Diseases; Trimethoprim, Sulfamethoxazole Drug Combination; Weight Loss; Whipple Disease

Topics: Adverse Drug Reaction Reporting Systems; Aged; Anemia, Hemolytic, Autoimmune; Anti-Infective Agents; Anticoagulants; Benzodiazepines; Caffeine; Canada; Ceftriaxone; Central Nervous System Stimulants; Child; Drug Interactions; Female; Humans; Ketolides; Middle Aged; Olanzapine; Peripheral Nervous System Diseases; Phytotherapy; Pulmonary Embolism; Rhabdomyolysis; Selective Serotonin Reuptake Inhibitors; Warfarin; Weight Loss

Whipple's disease is a rare chronic multi-systemic infectious disorder caused by the Gram-positive bacillus, Tropheryma whippelii. Infection may involve any organ in the body, and most commonly affects white men in the fourth to sixth decades of life. The most common presenting symptoms are gastrointestinal and include abdominal pain, diarrhoea, anorexia and associated weight loss. However, the variability in presentation is considerable and some patients may present with intermittent low-grade fever, neurological abnormalities (nystagmus, ophthalmoplegia, cranial nerve defects), migratory arthralgia, lymphadenopathy, or involvement of the cardiovascular system. In typical Whipple's disease, the most severe changes are seen in the proximal small intestine and biopsy reveals mucosal and lymph node infiltration with large, foamy histocytes, containing granules that stain positive with periodic acid-Schiff (PAS) reagent and represent intact or partially degraded bacteria. Extended antibiotic treatment (up to 1-year) is indicated. Life-long surveillance for recurrence is essential, once primary treatment has been completed. We report the case of a 58-year-old man who developed a rare infection with the actinobacterium, T. whippelii. The patient had suffered intermittent episodes of varying clinical symptoms associated with multiple hospital admissions and clinical diagnoses, spanning a period of 22 years. Historically, arthralgia was the primary manifestation in this patient and also was the chief complaint for which he was first hospitalized 22 years ago. At his most recent admission to our hospital department, his presenting symptoms were persistent fatigue, weight loss, arthralgia and diarrhoea. Thus, it is essential that clinicians retain a high index of suspicion for T. whippelii infection in patients who have a long-term history of arthritis, fever and diarrhoea.

Topics: Anti-Bacterial Agents; Arthralgia; Ceftriaxone; Diagnosis, Differential; Diarrhea; Doxycycline; Drug Therapy, Combination; Duodenoscopy; Duodenum; Fever; Humans; Intestinal Mucosa; Male; Middle Aged; Periodic Acid-Schiff Reaction; Treatment Outcome; Weight Loss; Whipple Disease