Efficacy of morning-only compared with split-dose polyethylene glycol electrolyte solution for afternoon colonoscopy: a randomized controlled single-blind study.

OBJECTIVES: Administering a purgative close to the time of colonoscopy is optimal for cleansing. The aim of this study was to compare the efficacy and tolerability of morning-only (AM-only) polyethylene glycol electrolyte solution (PEG-ELS) to split-dose (PM/AM) PEG-ELS for afternoon colonoscopy. METHODS: This was a single-center, prospective, randomized, investigator-blinded, non-inferiority study comparing AM-only to PM/AM PEG-ELS for afternoon outpatient colonoscopy. The primary end point was whole colon prep adequacy. Tolerance and polyp detection were secondary outcomes. RESULTS: Overall, 125 patients were randomized and 9 withdrew without taking any prep. Of 116 analyzed, 62 received AM-only prep and 54 received PM/AM prep. The whole colon prep was adequate in 92% in the AM-only group vs. 94% in the PM/AM group (95% lower confidence limit, LCL, for the difference=-11.3%, non-inferiority P=0.013), whereas the right colon prep was adequate in 93 and 92%, respectively (95% LCL=-7.8%, non-inferiority P=0.003). Polyp detection was greater, and not inferior, in the AM-only group (mean=1.57 vs. 0.94 polyps/patient, non-inferiority P=0.007). The overall incidence of adverse events was not significantly different between the two groups (P=0.273), but the AM-only group had lower incidence of abdominal pain (P=0.024). The AM-only group also had better sleep quality (P=0.007) and less interference with the previous workday (P=0.019). CONCLUSIONS: AM-only and PM/AM PEG-ELS are clinically equivalent with respect to cleansing efficacy and polyp detection. AM-only prep was associated with a lower incidence of abdominal pain, superior sleep quality, and less interference with workday before colonoscopy

Brucella melitensis-Induced Transaminitis.

Brucellosis is infrequently reported in the United States and is mostly an occupational hazard among workers engaged in livestock raising and processing. It is a systemic infectious disease and can involve the liver in varying ways, ranging from benign subclinical increases in serum aminotransferase levels to ominous chronic suppurative disease. It is endemic in many countries, primarily those of the Mediterranean region. It is usually treated with antibiotics. We present a case of a 37-year-old female who develope

A 55 Year-old Man With Mental Status Change and Severe Anemia

Case Presentation A 55 year-old male with past medical history significant for mentalretardation, a stage IV sacral decubitous ulcer, iron deficiencyanemia and gastrointestinal bleeding presented from a long termcare facility for acute onset of respiratory distress and change inmental status. On presentation the patient was found to have aGCS of three, and he was emergently intubated in the emergencydepartment for airway protection. Following intubation his vitalsigns were stable

Vitamins: Friend or Foe

Case Presentation A 39 year-old male presented to the emergency department withgeneralized body aches after a recent fall. The patient underwenturgent trauma evaluation and incidentally was found to havemultiple medications in his right colon on radiography (Figures1 and 2). The patient was immediately screened for a drugoverdose, but he admitted to taking a large amount of Ultra-Startvitamins that he purchased on the internet. Due to suspicionfor possible drug overdose, a nasogastric tube was placed, andpolyethylene glycol was administered to help the patient pass thepills from his bowels. Despite the large ingestion of vitamins, thepatient remained asymptomatic throughout his hospitalization

Primary Pancreatic Lymphoma Presenting as Acute Pancreatitis.

Primary pancreatic lymphoma (PPL) is a rare extranodal manifestation of any histopathologic subtype of non-Hodgkin lymphoma that predominantly involves the pancreas. Fewer than 2% of extranodal malignant lymphomas and 0.5% of all pancreatic masses constitute PPL.1 Common clinical manifestations include abdominal pain, jaundice, acute pancreatitis, small bowel obstruction, and diarrhea. The clinical and radiologic findings are not pathognomonic, and the diagnosis is established only after histopathologic and cytopathologic examination with confirmatory molecular testing. Although rare, this particular neoplasm is amenable to treatment even in very advanced stages