Delving into the Latest Updates on Westmead Millennium Institute for Medical Research with Synapse

Overview

ObjectiveTo determine whether an elevated hepatic steatosis index (HSI), a non-invasive test for possible metabolic dysfunction-associated fatty liver disease (MAFLD), is associated with the development of adverse pregnancy outcomes.Material and MethodsA retrospective cohort study was conducted on adult women with singleton pregnancies who delivered at two tertiary hospitals from August 2014 to December 2017. Aspartate aminotransaminase (AST) and alanine aminotransaminase (ALT) levels obtained 12 months pre-gravid, or during pregnancy but prior to screening for gestational diabetes mellitus (GDM), were extracted and linked with oral glucose tolerance test results. The HSI was calculated using the following equation: 8 × (ALT/AST ratio) + BMI (+2 if female; +2 if diabetes mellitus present) and considered elevated if >36. Multiple logistic regression analysis was used to quantify the association between elevated HSI and each composite adverse pregnancy outcome after adjusting for independent maternal risk factors.ResultsOver 40-months, 11929 women were eligible and of these, 1885 had liver enzymes collected. Women with an elevated HSI (>36) were more likely multiparous and overweight/obese compared to those women with a non-elevated HSI (≤36). Elevated HSI was significantly associated with a composite of adverse maternal outcomes (adjusted odds ratio (aOR) 1.55 95% CI 1.11-2.17, p=0.01), although a non-significant increased risk of a composite of adverse neonatal outcomes occurred after multivariable adjustment (aOR 1.17, 95% CI 0.94-1.45, p=0.17).ConclusionOver and above known maternal risk factors, women with elevated HSI were more likely to develop adverse maternal, but not adverse neonatal outcomes.

01 Jan 2018·BMJ OpenQ4 · MEDICINE

Serum lactate cut-offs asarisk stratification tool for in-hospital adverse outcomes in emergency department patients screened for suspected sepsis

Q4 · MEDICINE

ArticleOA

Author: Shetty, Amith L ; Iredell, Jonathan ; Green, Malcolm ; Macaskill, Petra ; Byth, Karen ; Fullick, Mary ; Lander, Harvey ; Thompson, Kelly

ObjectivesWe investigated specific lactate thresholds for adverse outcomes in patients presenting to emergency departments (EDs) with suspected sepsis identified based on the performance of a sepsis screening algorithm.Design and settingA standardised sepsis bundle was implemented across public hospitals in New South Wales, Australia, as a quality improvement initiative. A register of all adult ED presentations (≥18 years) meeting predefined criteria for sepsis was created, using a combination of data linkage and direct reporting from 97 participating sites.ParticipantsA total of 12 349 adult ED presentations with 8310 (67.3%) having serum lactate analysis on arrival. Analysis of outcomes was based on dataset for 12 349 subjects obtained through multiple imputation for missing data.InterventionsA sepsis management bundle including early antibiotic prescribing, fluid therapy and referral to intensive care unit (ICU) services was implemented.Outcome measuresA primary composite adverse event (AE) outcome of inhospital mortality (IHM) and/or prolonged ICU stay ≥72 hours (ICU 72 hours) was used for this study.ResultsThere was statistically significant increase both in the ORs of AE and IHM with each integer increase in serum lactate values. After adjusting for the presence of hypotension, the estimated ORs for the combined AE outcome were 2.71 (95% CI 2.05 to 3.57), 2.65 (95% CI 2.29 to 3.08), 3.10 (95% CI 2.71 to 3.53) and 3.89 (95% CI 3.36 to 4.50) for serum lactate levels at or above 1, 2, 3 and 4 mmol/L, respectively. The corresponding ORs for IHM were 2.93 (95% CI 2.08 to 4.13), 2.77 (95% CI 2.34 to 3.29), 3.26 (95% CI 2.80 to 3.80) and 4.01 (95% CI 3.40 to 4.73), respectively (all P<0.0001). More than 10% of patients with suspected sepsis and with serum lactate ≥2 mmol/L experienced a prolonged ICU stay or died in hospital.ConclusionsED sepsis screening algorithms intended to identify patient adverse outcomes should incorporate a serum lactate cut-off of ≥2 mmol/L as a threshold for the initiation of specific interventions and increased monitoring.

01 Sep 2017·Discovery medicineQ4 · MEDICINE

Role of nutrition, gene polymorphism, and gut microbiota in non-alcoholic fatty liver disease.

Q4 · MEDICINE

Review

Author: Lu, Yu ; Qiao, Liang ; Kong, Lingbo ; Nan, Yuemin ; Zhang, Siyu

Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease in the world. The nutrients play important roles in the development and progression of NAFLD. High-calorie diet, especially the diet rich in saturated fatty acids and cholesterol, as well as sugary drinks with high fructose content, induces hepatic steatosis and triggers progression of steatohepatitis, fibrosis, and even hepatocellular carcinoma. Disordered micronutrient status and gut microbiota are also involved in the pathogenesis of NAFLD. Nutrients related NAFLD could be aggravated by a genetic predisposition, for instance, genetic mutations in patatinlike phospholipase domain-containing 3 (PNPLA3) and transmembrane 6 superfamily member 2 (TM6SF2). Reduction of caloric intake through lifestyle interventions and use of dietary supplements such as omega-3 fatty acids, vitamins, and probiotics may help alleviate liver injury in NAFLD.

100 Deals associated with Westmead Millennium Institute for Medical Research

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100 Translational Medicine associated with Westmead Millennium Institute for Medical Research

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Pipeline

Pipeline Snapshot as of 17 Nov 2024

The statistics for drugs in the Pipeline is the current organization and its subsidiaries are counted as organizations,Early Phase 1 is incorporated into Phase 1, Phase 1/2 is incorporated into phase 2, and phase 2/3 is incorporated into phase 3

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