Brain Perfusion Scintigraphy in Evaluation of Pathogenesis of Fatigue in Patients with Primary Biliary Cholangitis (PBC) – A Pilot Study
Joanna Raszeja-Wyszomirska,
Piotr Zorga,
Marcin Kotulski,
Bożena Birkenfeld,
Piotr Milkiewicz Milkiewicz
Issue:
Volume 3, Issue 4, July 2017
Pages:
42-46
Received:
17 July 2017
Accepted:
23 August 2017
Published:
9 September 2017
Abstract: Primary biliary cholangitis (PBC) is an autoimmune cholestatic liver disease characterized by a breakdown of immune tolerance to mitochondrial and nuclear antigens, causing injury to the biliary epithelial cells. Fatigue is the commonest reported symptom in PBC and has a negative impact on patients' perceived quality of life, often through social isolation. It is unrelated to the severity of liver disease and appears unresponsive to current therapies, including ursodeoxycholic acid and transplantation. Fatigue in PBC is complex, with numerous associated peripheral and central nervous system (CNS) features. Initially, cholestasis causes degenerative CNS change affecting areas of the brain regulating autonomic dysfunction and sleep, and these changes lead directly to some manifestations of fatigue and the associated cognitive impairment. The aim of the study was to examine global cerebral blood flow with brain perfusion scintigraphy SPECT in well-defined group of PBC Caucasian patients with verbally reported fatigue. Twenty consecutive PBC female patients (median age 58.9, ranges 38-80; 4 cirrhotic) with mean duration of the disease 3.3 years, were prospectively enrolled into the study. Fatigue Impact Scale (FIS) questionnaire was administered to every patients at the moment of brain examination. Brain perfusion scintigraphy SPECT was performed after intravenous injection of 760-800 MBq of technetium99m labeled exametazime (99mTc –HMPAO). Then patients were examined using double head gamma camera system, and data were analyzed with dedicated nuclear medicine software. In analyzed cohort the median FIS score was 70.5 points (ranges 21-160), which was higher than previously reported. There were no correlation between age of patients at the SPECT/FIS examination, duration of the disease, the presence of liver cirrhosis, Mayo Risk Score, and FIS domains: Cognitive, Physical and Social, as well as with brain blood flow. However, positive correlation between Cognitive dimension of FIS measure and right frontal lobe perfusion impairment assessed with SPECT technic (p<0.05) was found. The results of this study showed that right lobe perfusion impairment might impact brain function in PBC. Cognitive dimension was stage-independent symptom in analyzed cohort, and cognitive impairment might be, in turn, associated with functional brain lesion.
Abstract: Primary biliary cholangitis (PBC) is an autoimmune cholestatic liver disease characterized by a breakdown of immune tolerance to mitochondrial and nuclear antigens, causing injury to the biliary epithelial cells. Fatigue is the commonest reported symptom in PBC and has a negative impact on patients' perceived quality of life, often through social i...
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A Histomorphological Study on the Olfactory Bulb of Diabetic Albino Rats
Muhamed Faizal,
Aijaz Ahmed Khan
Issue:
Volume 3, Issue 4, July 2017
Pages:
47-56
Received:
31 July 2017
Accepted:
18 August 2017
Published:
26 September 2017
Abstract: Long standing hyperglycemia is generally associated with a decline in the chemical senses including smell due to its unfavorable destructive effects on the small sized neurons of the Olfactory bulb (OB). Accordingly, the current study was aimed to analyze the effect of experimental hyperglycemia on OB of albino rats. To detect a possible change on the olfactory bulb during hyperglycemia, 36 albino rats were divided into six groups of six rats each and were designated as control, two week, one month, two month, four month and six month respectively. Diabetes was induced with single dose of streptozotocin (STZ-60 mg/kg, IP). The inductions of diabetes were confirmed by measuring the blood glucose levels in the tail blood with a Glucometer. At the end of each experimental period animals were euthanized by deep ether anesthesia and blood samples were collected by direct puncture of heart for biochemical analysis. Animals were perfused with Karnovsky fixative. After two days tissue specimen were collected and processed for light microscopic studies. Biochemical analysis of serum revealed increased serum creatinine and reduced serum total protein. Histopathology and histomorphometry of OB revealed that the progressively increasing duration of hyperglycemia was associated with noticeable decreased diameter of OB glomeruli, decrease diameter of mitral cells and thickening of supporting connective tissue around the OB and blood vessels. It is concluded that the association of the long-standing hyperglycemia with frequent occurrence of hypercellular glomeruli and misplaced mitral cells, decreased diameter of OB glomeruli and mitral cells, subtle laminar disarray and added deposition of collagen fibers around OB and blood vessels appear to be important contributing factors responsible for the derangement of olfactory function in diabetics.
Abstract: Long standing hyperglycemia is generally associated with a decline in the chemical senses including smell due to its unfavorable destructive effects on the small sized neurons of the Olfactory bulb (OB). Accordingly, the current study was aimed to analyze the effect of experimental hyperglycemia on OB of albino rats. To detect a possible change on ...
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