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Wild-mushroom intoxication — Clinical case
Abstracts
doi:10.1016/j.ejim.2013.08.204
Internal Medicine, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain
RO
OF
Background: There is a controversy about adipokine profile in hepatitis C virus (HCV) infection-associated liver steatosis, and their relationships with body fat stores, taking into account the different viral genotypes. Objective: In the present study we analyse the relationships of the amount of liver steatosis with fat stores at different parts of the body, insulin resistance, and serum adipokine levels, in treatment-naïve patients affected by HCV infection, considering also possible differences among genotypes. Methods: We included 85 HCV infected patients, and assessed the amount of liver fat by histomorphometry, and its relationships with fat and lean mass at different parts of the body (by densitometry), hormones (insulin, HOMA index), adipokines (resistin, adiponectin, leptin), and cytokines (tumor necrosis factor (TNF-α), interleukin (IL) 6). Results: Liver steatosis is related to fat mass at trunk (t = 2.45, p = 0.017 when patients with trunk fat over the median were compared with patients with trunk fat below the median), insulin (ρ = 0.27), HOMA index(ρ = 0.31), TNF-α (ρ = 0.22), and IL-6 (Z = 3.45; p b 0.04 in all the cases), but not with adiponectin, leptin, resistin, or leg fat. Genotype 3 infected patients showed more steatosis (7.78% vs 1.93%, Z = 2.52; p = 0.002), despite a trend to lower absolute values of insulin, HOMA and TNF-α, which were significantly lower than those observed in non 3 genotype patients when corrected by fat mass. Conclusions: Steatosis in HCV infection is common (82.2%), and closely related with trunk fat, but not with fat at the legs; to hyperinsulinaemia, insulin resistance, and TNF-α. Genotype 3 infected patients show significantly more steatosis than non-3 genotype infected individuals, and also a significantly decreased rate serum adipokine concentration to body fat amount.
TE
ID: 332 Wild-mushroom intoxication — Clinical case A.M. Griloa, D. Pintoa, M. Lopesa, J. Reinaa, J. Vaza, P. Alexandrinob
ID: 356 Adipokines and body fat stores in hepatitis C virus liver steatosis J. López-Prieto, E. González-Reimers, R. Pelazas-González, R. Hernández-Luis, M.C. Durán-Castellón, O. Elvira-Cabrera, M.C. Martín-González, I. Hernández-Betancor, M. Rodriguez-Gaspar, F. Santolaria-Fernández
DP
territory). Other elements are psychological consultations if indicated, educative lectures and group sessions. We also help to find continuing support at the hometown. Aim: The aim of this survey is to monitor the weight loss achieved by the patients in our program. Method: Body weight is monitored regularly and for the data presented we use the weight upon admission and before discharge. The medium length of stay is 27 days (3 to 5 weeks). Results: The medium weight of the patients upon admission was 149 (+/−27) kg — the medium BMI was 48 (+/−8) kg/m2 reaching from 35 to 73 kg/m2. The medium weight loss achieved by the patients during their stay in our clinic was 6.3 kg (standard deviation 3.6 kg) — statistical data will be shown in table form adapted to the weight loss per week of stay (average 1.6 (+/−0.8) kg). The overall weight loss in percentage of body weight was averagely 4.3 (+/−2.0) %. Conclusion and future perspective: A medium weight loss of 1.6 kg per week by far exceeds the amount that can be achieved by mere calorie reduction using a mixed moderately calorie reduced diet. A reduction of 500 kcal per day will only result in a medium weight loss of 0.5 kg per week. The advantage of our inpatient program is most likely the intense exercise program and the group support. Our aim is schooling the patients for a dietary and lifestyle modus that they can continue at home. The lasting effect of conservative weight loss programs so far has been very limited. In a future project we will obtain multiple data on the patients' history and factors concerning his obesity and correlate these data to the weight development one year after discharge. The aim is to find factors that are predictive for a failure or sustainable success of a conservative weight loss program.
e83
a
Internal Medicine I, José Joaquim Fernandes Hospital, Beja, Portugal Gastroenterology and Hepatology Intensive Care Unit, Santa Maria Hospital, Lisbon, Portugal
EC
b
doi:10.1016/j.ejim.2013.08.206
UN
CO
RR
Background: The growing use of wild mushrooms in culinary has led to an increase incidence of mushroom poisoning. Depending on the type of the mushroom, the adverse effects range from mild gastrointestinal symptoms to major cytotoxic effects resulting in organ failure and death. Methods and results: The authors report a case of a 63-year-old male, with past medical history of atrial fibrillation and hypertension, admitted at our hospital with nausea, vomiting and diarrhea with an evolution of two days evolution, after ingesting wild-mushrooms. There was no history of ingestion of other potential hepatotoxic drugs. On admission he was stable hemodynamically, presenting with abdominal pain. Liver function tests were elevated and hepatic virology was negative. With progressive hepatic damage indicated by persistent increase of aspartate aminotransferase and alanine aminotransferase, he was transferred to an Intensive Care Unit. The management consisted of intravenous hydration, and administration of silibinin and N-acetylcysteine. There was clinical improvement with progressive normalization liver function without the need for transplantation. Conclusion: In Portugal there is a traditional culture of picking and consumption of wild mushrooms especially in rural areas. Ingestion of potentially poisonous mushrooms occurs frequently, it typically results from misidentification but serious toxicity is uncommon. There are about twelve groups of identified mushroom toxins and fourteen described clinical syndromes. We present a clinical case of hepatotoxic syndrome as a profile presentation and therapeutic options available. doi:10.1016/j.ejim.2013.08.205
ID: 358 Serum sclerostin in hepatitis C virus infected patients E. González-Reimers, J. López-Prieto, R. Pelazas-González, R. Alemán-Valls, M.C. Martín-González, C. Jorge-Ripper, O. Pérez-Hernández, C. Fernández-Rodríguez, A. Martínez-Riera, F. Santolaria-Fernández Internal Medicine, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain
Background: Sclerostin is an endogenous inhibitor of the Wnt/βcatenin pathway secreted by osteocytes. It inhibits osteoblast function, differentiation, and survival. Theoretically, sclerostin tends to decrease bone mass, although several studies show opposite results. In addition, it may be related to insulin resistance and carbohydrate metabolism, as osteocalcin. Hepatitis C virus (HCV)-infected patients may present osteoporosis, and frequently show liver steatosis, in relation with insulin resistance. The behaviour of sclerostin in these patients is unknown. Objective: The aim of this work was to analyse the relationship between serum sclerostin and osteocalcin levels and bone mineral density (BMD), liver function derangement, the intensity of liver steatosis and biochemical markers of bone homeostasis and insulin resistance in HCV-infected patients. Methods: Forty HCV patients and twenty age and sex-matched
doi:10.1016/j.ejim.2013.08.204
Internal Medicine, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain
RO
OF
Background: There is a controversy about adipokine profile in hepatitis C virus (HCV) infection-associated liver steatosis, and their relationships with body fat stores, taking into account the different viral genotypes. Objective: In the present study we analyse the relationships of the amount of liver steatosis with fat stores at different parts of the body, insulin resistance, and serum adipokine levels, in treatment-naïve patients affected by HCV infection, considering also possible differences among genotypes. Methods: We included 85 HCV infected patients, and assessed the amount of liver fat by histomorphometry, and its relationships with fat and lean mass at different parts of the body (by densitometry), hormones (insulin, HOMA index), adipokines (resistin, adiponectin, leptin), and cytokines (tumor necrosis factor (TNF-α), interleukin (IL) 6). Results: Liver steatosis is related to fat mass at trunk (t = 2.45, p = 0.017 when patients with trunk fat over the median were compared with patients with trunk fat below the median), insulin (ρ = 0.27), HOMA index(ρ = 0.31), TNF-α (ρ = 0.22), and IL-6 (Z = 3.45; p b 0.04 in all the cases), but not with adiponectin, leptin, resistin, or leg fat. Genotype 3 infected patients showed more steatosis (7.78% vs 1.93%, Z = 2.52; p = 0.002), despite a trend to lower absolute values of insulin, HOMA and TNF-α, which were significantly lower than those observed in non 3 genotype patients when corrected by fat mass. Conclusions: Steatosis in HCV infection is common (82.2%), and closely related with trunk fat, but not with fat at the legs; to hyperinsulinaemia, insulin resistance, and TNF-α. Genotype 3 infected patients show significantly more steatosis than non-3 genotype infected individuals, and also a significantly decreased rate serum adipokine concentration to body fat amount.
TE
ID: 332 Wild-mushroom intoxication — Clinical case A.M. Griloa, D. Pintoa, M. Lopesa, J. Reinaa, J. Vaza, P. Alexandrinob
ID: 356 Adipokines and body fat stores in hepatitis C virus liver steatosis J. López-Prieto, E. González-Reimers, R. Pelazas-González, R. Hernández-Luis, M.C. Durán-Castellón, O. Elvira-Cabrera, M.C. Martín-González, I. Hernández-Betancor, M. Rodriguez-Gaspar, F. Santolaria-Fernández
DP
territory). Other elements are psychological consultations if indicated, educative lectures and group sessions. We also help to find continuing support at the hometown. Aim: The aim of this survey is to monitor the weight loss achieved by the patients in our program. Method: Body weight is monitored regularly and for the data presented we use the weight upon admission and before discharge. The medium length of stay is 27 days (3 to 5 weeks). Results: The medium weight of the patients upon admission was 149 (+/−27) kg — the medium BMI was 48 (+/−8) kg/m2 reaching from 35 to 73 kg/m2. The medium weight loss achieved by the patients during their stay in our clinic was 6.3 kg (standard deviation 3.6 kg) — statistical data will be shown in table form adapted to the weight loss per week of stay (average 1.6 (+/−0.8) kg). The overall weight loss in percentage of body weight was averagely 4.3 (+/−2.0) %. Conclusion and future perspective: A medium weight loss of 1.6 kg per week by far exceeds the amount that can be achieved by mere calorie reduction using a mixed moderately calorie reduced diet. A reduction of 500 kcal per day will only result in a medium weight loss of 0.5 kg per week. The advantage of our inpatient program is most likely the intense exercise program and the group support. Our aim is schooling the patients for a dietary and lifestyle modus that they can continue at home. The lasting effect of conservative weight loss programs so far has been very limited. In a future project we will obtain multiple data on the patients' history and factors concerning his obesity and correlate these data to the weight development one year after discharge. The aim is to find factors that are predictive for a failure or sustainable success of a conservative weight loss program.
e83
a
Internal Medicine I, José Joaquim Fernandes Hospital, Beja, Portugal Gastroenterology and Hepatology Intensive Care Unit, Santa Maria Hospital, Lisbon, Portugal
EC
b
doi:10.1016/j.ejim.2013.08.206
UN
CO
RR
Background: The growing use of wild mushrooms in culinary has led to an increase incidence of mushroom poisoning. Depending on the type of the mushroom, the adverse effects range from mild gastrointestinal symptoms to major cytotoxic effects resulting in organ failure and death. Methods and results: The authors report a case of a 63-year-old male, with past medical history of atrial fibrillation and hypertension, admitted at our hospital with nausea, vomiting and diarrhea with an evolution of two days evolution, after ingesting wild-mushrooms. There was no history of ingestion of other potential hepatotoxic drugs. On admission he was stable hemodynamically, presenting with abdominal pain. Liver function tests were elevated and hepatic virology was negative. With progressive hepatic damage indicated by persistent increase of aspartate aminotransferase and alanine aminotransferase, he was transferred to an Intensive Care Unit. The management consisted of intravenous hydration, and administration of silibinin and N-acetylcysteine. There was clinical improvement with progressive normalization liver function without the need for transplantation. Conclusion: In Portugal there is a traditional culture of picking and consumption of wild mushrooms especially in rural areas. Ingestion of potentially poisonous mushrooms occurs frequently, it typically results from misidentification but serious toxicity is uncommon. There are about twelve groups of identified mushroom toxins and fourteen described clinical syndromes. We present a clinical case of hepatotoxic syndrome as a profile presentation and therapeutic options available. doi:10.1016/j.ejim.2013.08.205
ID: 358 Serum sclerostin in hepatitis C virus infected patients E. González-Reimers, J. López-Prieto, R. Pelazas-González, R. Alemán-Valls, M.C. Martín-González, C. Jorge-Ripper, O. Pérez-Hernández, C. Fernández-Rodríguez, A. Martínez-Riera, F. Santolaria-Fernández Internal Medicine, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain
Background: Sclerostin is an endogenous inhibitor of the Wnt/βcatenin pathway secreted by osteocytes. It inhibits osteoblast function, differentiation, and survival. Theoretically, sclerostin tends to decrease bone mass, although several studies show opposite results. In addition, it may be related to insulin resistance and carbohydrate metabolism, as osteocalcin. Hepatitis C virus (HCV)-infected patients may present osteoporosis, and frequently show liver steatosis, in relation with insulin resistance. The behaviour of sclerostin in these patients is unknown. Objective: The aim of this work was to analyse the relationship between serum sclerostin and osteocalcin levels and bone mineral density (BMD), liver function derangement, the intensity of liver steatosis and biochemical markers of bone homeostasis and insulin resistance in HCV-infected patients. Methods: Forty HCV patients and twenty age and sex-matched