bluuebunny/crossref_metadata_2025_split huggingface dataset:
2976 Risk of Developing Non-Alcoholic Fatty Liver Disease (NAFLD) With Increased Intake of High Fructose Corn Syrup (HFCS): A Systematic Review
Authors: Gopalakrishnan Ravikumar Naveen Prasad , Nallapeta Naren S. , Mahl Thomas 
Published: October 2019

INTRODUCTION:
Non-alcoholic fatty liver disease (NAFLD) encompasses the spectrum of fatty liver disease without significant alcohol consumption. The pathogenesis of NAFLD is complex and according to the “multiple parallel hits hypothesis,” a number of different processes may contribute to liver inflammation. High fructose corn syrup (HFCS, a mixture of fructose and glucose monosaccharides) appears to have a major role in inducing fatty liver by both stimulating de novo lipogenesis and blocking β-fatty acid oxidation. We performed a systematic review to demonstrate the association of HFCS in NAFLD.

METHODS:
Two independent authors performed a thorough literature search of English language studies in PubMed, Embase, Medline, Google Scholar, and Science Citation Index to identify relevant studies between January 2010 to January 2018. Keywords used were “high fructose corn syrup,” “nonalcoholic fatty liver disease,” “nonalcoholic steatohepatitis,” “high fructose diet,” “fatty liver,” “hepatic metabolism,” “hepatic triglycerides,” “hepatic de novo lipogenesis” and “liver enzymes.” Effects of HFCS on changes in liver enzymes, hepatic metabolism, and risk of NAFLD were assessed. The strength of evidence was evaluated by considering precision, the risk of bias and consistency.

RESULTS:
Based on our search criteria 6 animal studies were identified and 3 were excluded after careful review. 3 animal (rat/mice) studies were included for our final analysis. We found a significant evidence from all three studies that consumption of HFCS diet increased de novo lipogenesis in association with up-regulation of fatty acid synthase, sterol regulatory element binding protein (SREBP)-1c and decreased β-oxidation with down-regulation of Peroxisome proliferator-activated receptor (PPARα) in the liver of rats. In addition, ALT (Alanine Aminotransferase) elevation and increased liver triglycerides content were observed in all the three studies.

CONCLUSION:
Our systematic review shows that HFCS intake is associated with increased risk of developing NAFLD. However, we need more trials looking at the association between HFCS intake and liver metabolism in the future.
2977 Mercury Exposure and Risk of Non-Alcoholic Fatty Liver Disease and Advanced Fibrosis: Findings From the 2011-2016 National Health and Nutrition Examination Survey
Authors: Reja Debashis , Visaria Aayush , Rustgi Vinod K. 
Published: October 2019

INTRODUCTION:
Mercury (Hg) is a well-known toxic metal that is most commonly found in diet (seafood, rice), and other sources such as dental amalgams and batteries. The pathogenesis for hepatoxicity is theorized to be triggered by oxidative stress. We aim to investigate the association of Mercury with key demographic and clinical factors, as well as NAFLD and Advanced Fibrosis.

METHODS:
A population of 5,590 non-pregnant individuals age 18-74 were included in this secondary analysis of NHANES 2011-2016. Exclusion criteria: AST/ALT >500 IU/L, alcohol >10 drinks/week (females)/>20 drinks/week (males), transferrin saturation >50%, positive hepatitis B and C serology. NAFLD was defined by Fatty Liver Index score >60. Advanced fibrosis was defined by National Fibrosis Score >0.676. Student's T-test was used for continuous and Rao-Scott Chi-Square test for categorical variables. Comparison across quartiles were done with simple linear regression for continuous, Rao-Scott Chi-Square test for categorical variables. Demographics and patient confounders were adjusted using multivariate logistic regression (SAS 9.4) for odds of NAFLD/Advanced Fibrosis with respect to Mercury quartile.

RESULTS:
5,590 patients were included, 44% with NAFLD and 56% without NAFLD. Patients with NAFLD vs no NAFLD were more likely to be older (51.1 vs 47.7 years, P < 0.0001), men (55% vs 45%, P < 0.0001), have fewer years of schooling, >high school (60% vs 69%, P < 0.0001), have lower Mercury levels (1.25 vs 1.68, P < 0.0003) and were significantly more likely to have higher BMI, Diabetes incidence, Hypertension, Total Cholesterol. Demographic and clinical characteristics for increased Mercury Levels by Quartile are listed in Table 1. Of note, participants with more Mercury exposure, in quartile 4 vs quartile 1, were older (53.4 vs 45.6 years, P < 0.0001), more educated (>high school 79% vs 53%, P < 0.0001), leaner (BMI 27.4 vs 29.6, P < 0.0001), higher HDL (55.8 vs 50.1), but had similar rates of GGT, ALT, AST, Hypertension, and Diabetes. There was no significant association found for risk of NAFLD or Advanced Fibrosis with Blood Mercury levels in both univariate or multivariate analysis.

CONCLUSION:
Our results show that Mercury levels are decreased in NAFLD, and are with increased with higher education and lower BMI. Mercury levels did not significantly affect liver enzymes or NAFLD risk factors such as hypertension and diabetes. Further studies are needed to examine Mercury toxicity and liver function.
2978 Hypothyroidism Is Associated With Lower Mortality in Hospitalized Patients With Cirrhosis
Authors: Panchal Dayna , Khawaja Umar Sharif , Choi Catherine , Motlaghazadeh Yasaman , Nasir Umair M. 
Published: October 2019

INTRODUCTION:
The liver is involved in the synthesis of thyroid binding proteins, the peripheral conversion of T4 to T3, and thyroid hormone conjugation and excretion. Consequently, liver dysfunction is associated with a decrease in thyroid hormone levels. Previous studies have supported thyroid hormone levels to have a predictive role for survival in critically ill patients. Here, we seek to evaluate if hypothyroidism influences survival in hospitalized patients with cirrhosis.

METHODS:
The National Inpatient Sample (NIS) is an inpatient database comprising approximately 20% of all inpatient admissions to hospitals in the United States. From the database, we collected data from hospitalized patients with cirrhosis listed as primary or secondary diagnosis and divided them into two subgroups: those with a diagnosis of hypothyroidism and those without. We reviewed and compared the two groups for mean hospital length of stay in days, Charlson comorbidity index as well as rates in mortality. IBM Statistical Package for the Social Sciences (SPSS) was used for statistical analysis.

RESULTS:
A total of 338, 990 cases of patients from the 2012-2014 NIS database had cirrhosis as primary or secondary diagnosis. 35,135 of these patients (10.36%) had hypothyroidism. The mean length of hospital stay in patients with cirrhosis and hypothyroidism was 5.1 days and 4.9 days for those without hypothyroidism. Charlson comorbidity index was significantly higher (P < 0.05) in cirrhotic patients with hypothyroidism. In the patients with cirrhosis, the mortality was 4%. In the subgroup with hypothyroidism, the mortality was 3.2% while the other subgroup without hypothyroidism was 4.1%. After adjusted for age, sex, race, and the Charlson comorbidity index, the group of patients with hypothyroidism had lower mortality (OR: 0.74, 95% CI (0.7-0.8).

CONCLUSION:
Our results show that cirrhotic patients with hypothyroidism had a higher comorbidity but a lower rate of mortality in the hospital than those without hypothyroidism. A review of the literature showed no consensus of suppressed total thyroid hormone level and its association with mortality. Some studies demonstrate that lower fT3 levels are directly associated with severity of liver disease and that lower fT3 was associated with higher mortality risk in the ICU setting. Further studies should be done to explore this association.
2979 Transoral Outlet Reduction With Endoscopic Suturing for Weight Regain in Gastric Bypass Patients: Preliminary Results From a Single Center in Puerto Rico
Authors: Marzan-Loyola Adriana , Gregory-Gonzalez Federico , Micames-Caceres Carlos 
Published: October 2019

INTRODUCTION:
Roux-en-y gastric bypass (RYGB) is currently one of the most common and effective weight loss procedures. The goal of bariatric surgery is not only to maximize weight loss but also to improve quality of life and attain nutritional health by reversing obesity-related comorbidities. Although RYGB is highly effective, weight regain or insufficient weight loss is common after the procedure. Insufficient weight loss and/or weight regain after bariatric surgery is commonly due to dilatation of the gastrojejunal anastomosis (GJA), thus reducing the restrictive capacity of the RYGB. For this reason, endoluminal interventions such as the Transoral Outlet Endoscopic Reduction (TORe) for GJA reductions have emerged as an alternative to invasive surgery revision.

METHODS:
Post-RYGB patients who experienced inadequate weight loss or significant weight regain and underwent TORe at Bella Vista Hospital in Puerto Rico were analyzed.

RESULTS:
A total of nine consecutive post-RYGB patients (mean age 53.7 yrs) underwent TORe a mean of 9.3 years after surgery. Average maximum weight loss was 85 lbs and average weight regain 47.9 lbs. Average weight was 233.1 lbs with an average body mass index (BMI) of 41.2 kg/m2 at the time of TORe. The average diameter of the GJ anastomosis prior to TORe was of 29.8mm (dilated diameter defined as >15 mm). After TORe the average diameter of the GJA was reduced to 6.1 mm with an average reduction of 23.7 mm (79.5% reduction). In 100% of cases the diameter of GJA was reduced to less than 12 mm. Five patients underwent pouch gastroplasty during the same session as TORe. No complications related to TORe were reported and all patients tolerated well the procedure. Follow up was provided to 9/9 patients at one month, 6/9 patients at three months and 3/6 patients at six months after the procedure with an average weight loss of 16.8 lbs, 32.6 lbs and 26.3 lbs, respectively.

CONCLUSION:
This clinical study, although limited by a small population size and the absence of a control group for comparison, suggests that TORe by endoscopic suturing may represent a safe and effective alternative for post-RYGB patients with insufficient weight loss and/or weight regain. Prospective studies with increased number of patients in our population are warranted to confirm these results.
2980 Obesity Does Not Increase Risk of Mortality in Necrotizing Pancreatitis
Authors: Bhurwal Abhishek , Tawadros Augustine , Pioppo Lauren , Reja Debashis , Sarkar Avik , Shahid Haroon , Tyberg Amy , Kahaleh Michel 
Published: October 2019

INTRODUCTION:
Obesity is considered an independent risk factor for increased severity of acute pancreatitis. However, the association of obesity with acute necrotizing pancreatitis and the impact on outcomes of necrotizing pancreatitis is sparsely described. Therefore, we aimed at impact of obesity on necrotizing pancreatitis in terms of inpatient mortality, length of stay and hospitalization charges.

METHODS:
This was a retrospective study utilizing the 2016 National Inpatient Database for all principal discharges of acute pancreatitis in obese patients more than 18 years of age utilizing ICD 10 codes. Primary outcomes were incidence of necrotizing pancreatitis in obese patients. Secondary outcomes were mortality, impact on healthcare utilization between the two cohorts. Multivariate analysis was utilized to adjust for confounders for evaluation of predictors of mortality. Poisson regression was performed for length of stay and hospitalization charges.

RESULTS:
Among total of 288,479 discharges with principal diagnoses of Acute Pancreatitis, 13.83% were associated with obesity. Acute necrotizing pancreatitis was associated with only 0.8% of the obese population with pancreatitis. There were no significant differences in terms of age, gender, ethnic differences in obese and normal BMI cohort. Acute kidney injury in necrotizing pancreatitis was more frequently observed in obese patients. There were no increased odds of mortality in obese patients with necrotizing pancreatitis as compared to patients with normal BMI after adjustment of confounders. Increasing age and male gender were significantly associated with increased odds of mortality in necrotizing patients. The length of stay was not significantly different in either of the cohorts (11.72 days vs 14.53 days). However, hospitalization charges were significantly higher in obese patients with necrotizing pancreatitis (27,867$ vs 44,113$, P 0.02).

CONCLUSION:
Even though obesity is an independent risk factor for severity of acute pancreatitis, incidence of obesity with necrosis was infrequent from a National Cohort. Acute kidney injury was more common in setting of obesity with necrosis which might explain the increased severity. However, obesity did not independently increase the odds of mortality in setting of necrotizing pancreatitis. Increasing age and male gender in setting of necrotizing pancreatitis leads to increased mortality. Further studies are warranted to elucidate the association of gender and necrotizing pancreatitis.
2983 Impact of Proper History Taking Upon Healthcare Cost
Authors: Saleem Saad , Weissman Simcha , Bleibel Wissam 
Published: October 2019

INTRODUCTION:
The most important action that a healthcare provider can take to establish an accurate diagnosis is to elicit a precise history from the patient, however its the most neglected part. In this modern world, physicians rely on machines for diagnosing the pathology. In this study, we evaluated the outcome of proper history taking on establishing a diagnosis and its effect on hospital length of stay and cost.

METHODS:
A cross-sectional analysis was conducted using the de-identified data from the national health database, the Healthcare Cost and Utilization Project (HCUP). We identified the hospital encounters for “Spontaneous bacterial peritonitis (SBP)” using international classification of Diseases (ICD-9) diagnostic codes from 2011 to 2014. We assessed the prevalence of abdominal pain in the inpatient SBP cohort and determined whether the prevalence of abdominal pain varied with hospital stay and cost. The inclusion criteria included age between 30-60 years, history of liver cirrhosis, and ascites. Exclusion criteria included a history of dementia and hepatic encephalopathy as these patients were unable to provide history on admission. P-values less than 0.05 indicated a statistically significant association. Age was compared with Student T-test, and Categorical factors were compared with Chi-square tests. Data were analyzed using SPSS.

RESULTS:
A total of 1,854 SBP inpatient admissions were identified with prevalence of abdominal pain (history) 3.61%. Demographics between abdominal pain and without it included; age - mean with standard deviation (SD) 49.40 + 11.04 yrs vs. 55.15 + 22.10 yrs (P = 0.16), sex - male 47 (70.1%) vs. 1212 (67.8%), length of stay (mean with SD) 4.82 + 3.03 yrs vs. 6.25 + 5.44 yrs (P = 0.03), number of diagnosis on discharge (mean with SD) 15.78 + 5.2 vs. 14.87 + 5.1 (P = 0.15), number of procedures (mean with SD) 2.03 + 2.139 vs. 2.30 + 2.121 (P = 0.3) and hospital charges (mean with SD) $31757.79 + $23904 vs. $47650 + $58501 (P = 0.02).

CONCLUSION:
This study concluded that the proper history taking streamlined the patients into the accurate diagnosis and management of the disease, reducing the hospital length of stay and healthcare cost. Through our study, the awareness will spread in the healthcare society about the significance of the history and physical examination, therefore, decreasing the healthcare cost.
2995 Gastrointestinal Upset: Could E-Cigarettes Be the Cause?
Authors: Debnath Dipanjan , Singh Pratiksha , Rao Vanjarapu Jagan Mohan , Wert Yijin , Shrimanker Isha , Goel Siddharth , Nookala Vinod , Cheriyath Pramil 
Published: October 2019

INTRODUCTION:
In the United States, use of electronic cigarette (EC) has seen an exponential rise with 12.6% of adults using an EC at least once in their lifetime, with use differing by age, sex, and race. The level of nicotine exposure with EC is highly variable with its liquids containing 14.8 to 87.2 mg/ml of nicotine. Its use has been documented to be associated with adverse effects on the respiratory, nervous, cardiovascular, and gastrointestinal (GI) system. Common adverse effects on the GI system include xerostomia, oral mucositis, tongue discoloration, gingivitis, gum bleeding, nausea, vomiting, heartburn, and altered bowel habits.

METHODS:
A retrospective review of the National Health and Nutrition Examination Survey (NHANES) data between 2015-16 was conducted. Data regarding the use of EC and a history of vomiting and diarrhea over a period of 30 days were analyzed. Additionally, data regarding age and sex were analyzed. A P-value of < 0.05 was considered statistically significant. Continuous and categorical variables were analyzed using the two-sample t-test and the Chi-Square test, respectively. All the analyses were done in SAS 9.4 (SAS Institute, Cary, NC).

RESULTS:
A total of 944 participants were included in the study. Of these, 261 participants (males 62.84%) used EC at least one day and 683 participants (males 54.76%) never used EC, during the preceding 30 days. Amongst EC users (n = 261), 10.73% had a stomach or intestinal illness manifesting as vomiting or diarrhea that started during those 30 days compared to 8.64% who never used EC during the same period (n = 683). However, the results did not reach statistical significance (P = 0.3208).

CONCLUSION:
Conflicting views exist regarding the effects of EC on the GI tract. Our study demonstrated an association between EC consumption and vomiting and diarrhea. The study results are to be viewed taking into consideration the limitations of a smaller sample, shorter duration, existing comorbidities, and undefined nicotine content in the EC. Although recent studies have shown no effect of EC on the oral or gut microbiota, our study findings could be attributed to EC induced alteration of motility or irritation of the GI tract. However, further studies are required to establish a causal relationship and enunciate the mechanism by which EC components affect the GI tract. Careful consideration and diligence about the health effects of EC is required before it is assumed to be safe as a cigarette substitute or as a means of smoking cessation.
3006 Levofloxacin: Beyond Tendon Ruptures
Authors: Sahami Nima , Poudel Rosina 
Published: October 2019

INTRODUCTION:
Fluoroquinolones have long been an antibiotic of choice for their broad spectrum coverage. The medical community is well aware of its common side effects such as tendon rupture and Qt prolongation. However, there have been documented life threatening hypoglycemic episodes associated with Fluoroquinolones when used concurrently with oral hypoglycemic agents. Severe hypoglycemia may not be evident in this population after a single dose, but multiple factors when present concurrently places these patients at risk of life threatening hypoglycemic events.

CASE DESCRIPTION/METHODS:
Patient is a 52 year old female with a past medical history of T2DM on glimepiride and metformin, CKD-IIIa, OSA, HTN, HFpEF, presented with AMS for 1 day. On arrival BG was 22 and patient was only responsive to painful stimuli which temporarily resolved with 2 amps of D50. Two days prior patient was treated with levofloxacin for a URI. Patient endorsed decreased oral intake, decreased urine output for 2 days, and taking scheduled 20 mg of Lasix BID for heart failure. Review of systems was otherwise negative and patient was compliant with medications. Shortly after admission, patient started having severe hypoglycemia despite repeated doses of D50 and D 10 ggt was initiated. Pertinent lab findings revealed reduced renal function. After the initial 16-40 hours required for clearance of glimepiride, patient still required D10 drip to maintain euglycemia. At this point we other causes of sustained hypoglycemia such as insulinoma, exogenous insulin use, and levofloxacin induced hypoglycemia were entertained. A hypoglycemic agent screen, insulin levels, c-peptide were consistent with endogenous increase of insulin. Fifty five hours after last dose of levofloxacin blood glucose levels were stabilized and patient was D10 drip was discontinued and subcutaneous insulin was initiated. Renal function returned to baseline and patient was discharged on metformin and lifestyle modifications.

DISCUSSION:
The mechanism of fluoroquinolones induced hypoglycemia is thought to due to stimulation of pancreatic beta cells causing hyperinsulinemia and interference with the CYT P450 enzymes leading to supratheraputic levels of antihyperglycemic agents such as glimepiride. These factors in conjunction with reduced renal function create the perfect storm which can precipitate life threatening hypoglycemia. Thus, Fluoroquinolones induced hypoglycemia should be on the differential in diabetic patients recently treated for URI infections.
3010 Duplicated Gallbladder: A Rare Cause of Recurrent Cholecystitis in a Hispanic Woman
Authors: Bello Fatimah O. , Rivas Cynthia , Tijani Aramide , Rivera Arturo Suplee , Cantazaro Brandon , Rapoport Grigoriy , Herrera Henry R. 
Published: October 2019

INTRODUCTION:
Duplicated gallbladder (DG) is a rare congenital anomaly, affecting approximately 1 in 4000 births. Few reports exist describing acute cholecystitis in DG patients, with even less case reports of chronic cholecystitis. In this case we present a case of CC in a Hispanic woman with a DG.

CASE DESCRIPTION/METHODS:
A 49-year-old Hispanic woman with a history of dyslipidemia and diabetes presents to the ED with a 5-hour history of 10/10 crampy, mid-epigastric, non-radiating abdominal pain associated with subjective fevers, nausea and non-bloody, non-bilious vomiting. Patient had similar pain episodes in the past requiring hospital admissions. She was hemodynamically stable with a physical exam remarkable for moderate distress from pain and significant epigastric and right lower quadrant abdominal tenderness on palpation. Laboratory exam was significant for WBC- 12 th/uL (N: 4.8-10.9 th/uL), hemoglobin - 9.0 gm/dL (10.8-14.7 gm/dl) and ALP- 133 IU/L (N: 34-104 IU/L). Urinalysis was positive for WBC, bacteria, leukocyte esterase and nitrite. Abdominal ultrasound, CT abdomen and HIDA scan were suggestive of a DG. The patient was taken for a cholecystectomy. In the OR she was found to have a DG with 2 fundi merged at the Hartman's pouch, likened to the Boyden's vesica fellea divisa classification type. Pathology results revealed chronic cholecystitis and cholesterolosis in the DG. Patient continues to maintain significant clinical improvement post-surgery and she continues to be under close follow-up.

DISCUSSION:
CC is defined by the histopathologic appearance of chronic inflammation of the gallbladder and is believed to develop due to the presence of gallstones, although cases of acalulous CC also exist. As in our case, patients typically present with pain, however pain severity and liver enzyme alterations do not usually correlate with disease presence. To the best of our knowledge, no similar cases have been reported in the Hispanic population. In patients presenting to the ER, a high index of suspicion is recommended to improve overall patients' outcomes especially in patients presenting with multiple disease processes.