Background: The link between bilirubin and cardiometabolic outcomes has been previously identified with positive health effects of mild hyperbilirubinaemia. On the other hand, recent evidence has suggested an association between low circulating bilirubin levels and obesity. This study was conducted to assess the association of total bilirubin levels with metabolic and cardiovascular risk factors related to obesity. Methods: A total of 50 obese adults and 50 healthy controls matched for age and sex were enrolled in this study. Anthropometric measurements, fasting glucose, fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR), HOMA- β (%), lipids profile, monocyte to lymphocyte ratio (MLR), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), uric acid, gamma glutamyl transpeptidase (GGT), AST/ALT ratio and total bilirubin were assessed. Results: Total bilirubin, high density lipoprotein cholesterol (HDL-C) and AST/ALT ratio were significantly lower, whereas fasting insulin, HOMA-IR, total cholesterol, triglycerides, low density lipoprotein cholesterol, NLR, uric acid and GGT were significantly higher in obese adults than in healthy controls. Bilirubin was negatively associated with body mass index, waist circumference, fasting insulin, HOMA-IR, NLR, PLR, uric acid, and positively associated with HDL-C. HDL-C and NLR were the independent predictor variables of total bilirubin. Conclusion: Among all the studied cardio-metabolic risk factors, HDL-C and NRL are the most closely associated variables with total bilirubin levels in obese adults.
Dieulafoy's lesion (DL) is a rare but important cause of obscure gastrointestinal bleeding that may be overlooked during diagnostic endoscopy. Mortality rates are similar to those of other causes for gastrointestinal bleeding. Diagnosis by upper endoscopy is the modality of choice during acute bleeding. In the absence of active bleeding, the lesion resembles a raised nipple or visible vessel. There are no guidelines regarding effective selective therapy for DL, when diagnosed, endoscopist experience is the major determinant of the treatment strategy. Following our strategy, an expert endoscopist with a skilled assistant should have a high rate of successful DL diagnosis when an obscured gastrointestinal lesion is suspected. Cyanoacryltes compounds have been used successfully in management of Gastric varices and DLs. To our knowledge, there have been no previous reports regarding use of isoamyl-2-cyanoacrylate (AMCRYLATE(®); Concord Drugs Ltd., Hyderabad, India) as an effective therapy for gastric DL without serious complications. In our case study, Isoamyl-2-cyanoacrylate (AMCRYLATE(®)) was effective and safe for treating DL. Surgical wedge resection of the lesion should be considered as a therapeutic option if endoscopic therapy fails.
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