Recently, several studies have suggested that non selective beta-blockers (NSBB) may have beneficial effects in patients with acute on chronic liver failure (ACLF) through reducing the severity of inflammatory response. On the other hand, the use of beta blockers remains controversial in non-cirrhotic patients with septic shock. The aim of this study was to explore the impact of NSBB in patients with ACLF and distributive shock requiring vasopressors (norepinephrine). Patients and methods: Eighty consecutive patients with ACLF admitted from June 2010 to Sept 2015 in a specialized ICU were retrospectively studied. All patients had distributive circulatory failure defined by the need for norepinephrine to achieve a target mean arterial pressure of 65mmHg after adequate fluid resuscitation. The study subjects were classified into NSBB+ (receiving NSSB) and NSBB- (not receiving NSBB) groups. Patients were followed up from admission in the ICU to death, transplantation or last follow up visit for patients alive without transplant at the end of the study. Results: The study population included 58 males and 22 females. The mean age of the study participants was 54 ± 9 years. Causes of cirrhosis were alcohol in 62%, HCV in 19%, HBV in 6% and others in 16%. Mechanical ventilation (MV) and renal replacement therapy (RRT) were used in 72% and 49% patients, respectively (including 40% with both MV and RRT in addition to vasopressors). Forty patients out of eighty (50%) were receiving NSBB at admission (NSBB+). The mean of the MELD score at admission was not significantly different in NSBB+ (29) and NSBB- (32) patients. No significant difference was found between the 2 groups (NSBB+ vs NSBB-) regarding age (56 vs 52-y), gender (72 % vs 72% males), rate of MV (69% vs 75%), rate of RRT (41% vs 57%), rate of empirical antibiotics before admission (65% vs 52%), and rate of documented infection after admission (85% vs 78%). The proportion of patients who were transplanted was not significantly different in the 2 groups (20% vs 7%, p=0.1). Transplant free-survival (Kaplan-Meier) was significantly better in NSBB+ as compared to NSBB- patients (48% vs. 15% at 28-day, respectively, p=0.007). On multivariate analysis (Cox model including NSBB and MV), only NSBB was significantly and independently predictive of survival (p=0.02). Conclusion: The results of this series suggest that NSBB intake at admission of patients with ACLF and circulatory failure requiring administration of vasopressors is associated with better outcome, irrespective of the presence or absence of bacterial infection.

The incidence of thyroid dysfunction in diabetic patients is higher than that of the general population. Undiagnosed thyroid dysfunction may affect the metabolic control and enhance cardiovascular and other chronic complication risks in diabetic patients. Few studies have examined the relationship between subclinical hypothyroidism (SCH) and vascular complications of type 2 diabetes. Objectives: To find out the relationship between SCH and vascular complications in patients with Type 2 diabetes. Subjects and Methods: Our cross sectional study included 110 patients with type 2 DM (45 males and 65 females) who were followed at the Diabetes outpatient Clinics in the state of Kuwait during 6 months period. All patients subjected to complete clinical and laboratory data, including thyroid function tests, total cholesterol (TC), triglyceride (TG), HDL-C, LDL-C, urinary albumin, fundus examination, ECG, and Glycosylated hemoglobin. Results: Among 110 patients, 21 (19.1%) Patients had SCH. Patients with SCH were more significantly older, with longer duration of diabetes, higher HbA1c, total cholesterol and LDL-C than euthyroid group. However, gender (p = 0.076), BMI (p = 0.092), and smoking (P=0.715) were not significantly different between the SCH and euthyroid groups. The SCH group had a higher prevalence of dyslipidemia (p = 0.017), diabetic nephropathy (p = 0.003) diabetic retinopathy (p = 0.004) and IHD (p =0.011) than the euthyroid group while no significant difference in the prevalence of diabetic neuropathy (p=0.420). Conclusions: SCH is a common endocrine disorder in patients with Type 2 diabetes. It could be associated with a higher prevalence of vascular complications in type 2 diabetes. We could not prove a relation between SCH and diabetic neuropathy.

Objective: To study Thy1 as a fibroblast marker, SSEA1 as a marker of intermediate pluripotency and Oct4 as a marker of established pluripotency in rat model of endometriosis Design: In vivo animal study Materials and Methods: Endometriosis was induced in 20 albino female rats through autologous transplantation of one uterine horn to mesentery of intestine. Other 20 rats had their horn removed without transplantation (controls). Rats were sacrificed 4 weeks after induction surgery. Ectopic, eutopic and control endometria were harvested from endometriosis and control animals respectively. Quantitative syber green based RT-PCR was used to detect expression of Thy-1 (CD90), FUT4 (SSEA1), POU5F1 (Oct4) genes in tissues. Relative expression was normalized to that of β actin. In addition, Thy1, SSEA1 and Oct4 protein expression were detected by immunohistochemistry. Immunoscores were calculated by averaging number of positive cells in 10 non-overlapping high power fields in each section. Results: Ectopic endometrium expressed significantly higher mRNA of Oct4 and SSEA1 as compared to control endometrium. Expression levels of OCT4 and SSEA1 were comparable between ectopic and eutopic endometria and between eutopic and control endometria. Thy1 (CD90) gene expression level was comparable among ectopic, eutopic and control endometria (table 1). Oct4 immunoscore were significantly higher in ectopic (6.6±0.91) than eutopic (2.5±0.78) or control endometrium (3.7±0.1) (P value 0.02). Thy1 and SSEA1 immunoscores were comparable among all three types of endometria Conclusions: Using rat model of endometriosis, ectopic endometrium showed significantly higher Oct4, SSEA1, but similar Thy1 gene expression to that of control endometrium. This indicates increased transition from somatic to pluripotent cell states in ectopic endometrium which may play a role in endometriosis pathogenesis.

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