Juul (United States)

Hyperammonaemic encephalopathy in the absence of liver failure is a major diagnostic challenge. A rare cause is as a complication to previous gastric bypass surgery, a condition reported to be associated with high mortality. In this case report, we present the exhaustive diagnostic work-up and clinical reversal of deep and recurrent hyperammonaemic encephalopathy in a patient with previous gastric bypass surgery. As a key finding, the patient exhibited an extreme reduction of the in vivo capacity for urea synthesis, which was reverted by long-standing correction of severe protein and micronutrient malnourishment (Functional Hepatic Nitrogen Clearance; 2.9 to 25.5 L/h). In addition, we observed reduced levels of fasting plasma amino acids (α-amino nitrogen; 2.7 to 3.6 mmol/L) and glucagon (0.3 to 2.6 pmol/L) before clinical improvement, which may contribute to the non-functioning urea synthesis. These observations elucidate the underlying pathophysiology of hyperammonaemia as a complication of gastric bypass and highlight a potential mechanism – non-functioning urea cycle as a result of protein malnourishment and hepatic glucagon resistance.

[This corrects the article DOI: 10.3389/fchem.2023.1212744.].

SummaryThe role of integrating genomic scores (GSs) needs to be assessed. Adding a GS to recommended stratification tools does not improve the prediction of very low bone mineral density. However, we noticed that the GS performed equally or above individual risk factors in discrimination.PurposeWe aimed to investigate whether adding a genomic score (GS) to recommended stratification tools improves the discrimination of participants with very low bone mineral density (BMD).MethodsBMD was measured in three thoracic vertebrae using CT. All participants provided information on standard osteoporosis risk factors. GSs and FRAX scores were calculated. Participants were grouped according to mean BMD into very low (<80 mg/cm3), low (80–120 mg/cm3), and normal (>120 mg/cm3) and according to the Bone Health and Osteoporosis Foundation recommendations for BMD testing into an “indication for BMD testing” and “no indication for BMD testing” group. Different models were assessed using the area under the receiver operating characteristics curves (AUC) and reclassification analyses.ResultsIn the total cohort (n=1421), the AUC for the GS was 0.57 (95% CI 0.52–0.61) corresponding to AUCs for osteoporosis risk factors. In participants without indication for BMD testing, the AUC was 0.60 (95% CI 0.52–0.69) above or equal to AUCs for osteoporosis risk factors. Adding the GS to a clinical risk factor (CRF) model resulted in AUCs not statistically significant from the CRF model. Using probability cutoff values of 6, 12, and 24%, we found no improved reclassification or risk discrimination using the CRF-GS model compared to the CRF model.ConclusionOur results suggest adding a GS to a CRF model does not improve prediction. However, we noticed that the GS performed equally or above individual risk factors in discrimination. Clinical risk factors combined showed superior discrimination to individual risk factors and the GS, underlining the value of combined CRFs in routine clinics as a stratification tool.

Introdução: Atualmente, o uso do cigarro comum tem sido substituído pelo cigarro eletrônico, também conhecido como vape, juul, smok e pen-drive, constituindo-se numa verdadeira moda entre os jovens. O objetivo deste trabalho é analisar na literatura o impacto do uso cigarro eletrônico na saúde dos usuários. Método: Foi realizada uma construção de uma análise da literatura com passos pré-definidos, uma vez que ela contribui para o processo de sistematização e análise dos resultados, visando a compreensão de determinado tema, a partir de outros estudos independentes. Resultados: Na busca inicial foram escolhidos trabalhos, e, após aplicação dos filtros e leitura dos títulos, foram excluídos por estarem repetidos nas bases de dados e por se enquadrarem nos critérios de exclusão. Discussão: Levamos em consideração o uso contínuo do cigarro comum, e a descoberta recente para a troca entre ele, e o cigarro eletrônico, com a pauta de que os efeitos são diferentes, e os danos são menores. Conclusão: este trabalho visou elucidar as consequências ao uso do cigarro eletrônico como uma alternativa para o cigarro tradicional.