Evaluation of health related quality of life in irritable bowel syndrome patients

Background: Quality of life (QOL) is an important measure in the management of Irritable Bowel Syndrome (IBS). Controversy exists in the findings of studies evaluating QOL in IBS subtypes, and little is known about this issue in Iranian patients. Determination of the factors affecting QOL in IBS patients may influence treatment outcomes. The aims of this study are to: 1) compare QOL between subtypes in a sample of Iranian IBS patients, 2) determine the factors associated with QOL in IBS. Methods: This cross sectional study included two hundred and fifty IBS patients with the mean age ( ± standard deviation) of 31.62 ( ± 11.93) years that were referred to outpatient gastroenterology clinic. IBS patients were diagnosed based on Rome-3 criteria by a gastroenterologist, and then they were categorized into three subtypes according to the predominant type of bowel habit. The “QOL specific for IBS”, “Stait-trait anxiety inventory”, and “Beck depression inventory-2 ” questioners were used to evaluate QOL, anxiety, and depression symptoms, respectively. Results: The mean QOL scores in IBS mixed subtype (71.7 ± 25.57), constipation predominant subtype (80.28 ± 25.57), and diarrhea predominant subtype (76.43 ± 19.13) were not different. (P value: 0.05) In multivariate linear regression analysis, anxiety symptom scores were inversely correlated with QOL scores. [Standardized beta:-0.43, (95 % confidence interval:-0.70,-0.39), P value: < 0.01] Conclusion: It seems reasonable to manage anxiety symptoms properly in IBS patients since this might increase their QOL

Prevalence and clinical impact of alcohol withdrawal syndrome in alcohol-associated hepatitis and the potential role of prophylaxis: a multinational, retrospective cohort study

Alcohol withdrawal syndrome; Alcohol-associated hepatitis; BenzodiazepinesSíndrome de abstinencia alcohólica; Hepatitis asociada al alcohol; BenzodiazepinasSíndrome d'abstinència d'alcohol; Hepatitis associada a l'alcohol; BenzodiazepinesBackground The prevalence and impact of alcohol withdrawal syndrome (AWS) in patients with alcohol-associated hepatitis (AH) are unknown. In this study, we aimed to investigate the prevalence, predictors, management, and clinical impact of AWS in patients hospitalized with AH. Methods A multinational, retrospective cohort study enrolling patients hospitalized with AH at 5 medical centres in Spain and in the USA was performed between January 1st, 2016 to January 31st, 2021. Data were retrospectively retrieved from electronic health records. Diagnosis of AWS was based on clinical criteria and use of sedatives to control AWS symptoms. The primary outcome was mortality. Multivariable models controlling for demographic variables and disease severity were performed to determine predictors of AWS (adjusted odds ratio [OR]) and the impact of AWS condition and management on clinical outcomes (adjusted hazard ratio [HR]). Findings In total, 432 patients were included. The median MELD score at admission was 21.9 (18.3–27.3). The overall prevalence of AWS was 32%. Lower platelet levels (OR = 1.61, 95% CI 1.05–2.48) and previous history of AWS (OR = 2.09, 95% CI 1.31–3.33) were associated with a higher rate of incident AWS, whereas the use of prophylaxis decreased the risk (OR = 0.58, 95% CI 0.36–0.93). The use of intravenous benzodiazepines (HR = 2.18, 95% CI 1.02–4.64) and phenobarbital (HR = 2.99, 95% CI 1.07–8.37) for AWS treatment were independently associated with a higher mortality. The development of AWS increased the rate of infections (OR = 2.24, 95% CI 1.44–3.49), the need for mechanical ventilation (OR = 2.49, 95% CI 1.38–4.49), and ICU admission (OR = 1.96, 95% CI 1.19–3.23). Finally, AWS was associated with higher 28-day (HR = 2.31, 95% CI 1.40–3.82), 90-day (HR = 1.78, 95% CI 1.18–2.69), and 180-day mortality (HR = 1.54, 95% CI 1.06–2.24). Interpretation AWS commonly occurs in patients hospitalized with AH and complicates the hospitalization course. Routine prophylaxis is associated with a lower prevalence of AWS. Prospective studies should determine diagnostic criteria and prophylaxis regimens for AWS management in patients with AH

Effects of Corneal Nerve Density on the Response to Treatment in Dry Eye Disease

Purpose To evaluate whether levels of corneal subbasal nerve fiber length (SNFL) in dry eye disease (DED) could prognosticate the level of improvement in signs and symptoms after treatment. Design Phase IV, double-masked, randomized clinical trial. Participants Sixty patients with meibomian gland dysfunction-associated DED and 27 age-matched controls. Methods Patients with DED were randomized to receive topical artificial tears, loteprednol etabonate 0.5%, or loteprednol etabonate 0.5%/tobramycin 0.3% twice daily for 4 weeks. At baseline, in vivo confocal microscopy of central cornea was performed in both eyes. Patients with DED were divided into 2 subgroups, those with low baseline SNFL and those with near-normal baseline SNFL (the cut-off point: mean SNFL in controls minus 2 standard deviations). Clinical signs and symptoms at baseline and after 4 weeks of treatment were compared between the subgroups with low and near-normal SNFL for all therapeutic groups. Main Outcome Measures Symptom questionnaires, corneal fluorescein staining (CFS), conjunctival staining with lissamine green, tear break-up time, Schirmer’s test, and SNFL. Results In patients with DED, baseline SNFL (17.06 ± 5.78 mm/mm2) was significantly lower than in controls (23.68 ± 3.42, P=0.001). In the artificial tear and loteprednol groups, although no significant improvement in any sign or symptom was noted in patients with low baseline SNFL (<16.84 mm/mm2), subjects with near-normal baseline SNFL (≥16.84 mm/mm2) showed significant improvement in both symptoms and corneal fluorescein staining (CFS) score (all P<0.05). In the loteprednol/tobramycin group, no significant change was evident for any sign or symptom in either subgroup of low or near-normal baseline SNFL. Conclusions Significant improvements in CFS and patient symptomatology after DED treatment were evident only in the subgroup with near-normal corneal SNFL. Consideration of SNFL may thus assist in explaining the variability of patients’ response to DED therapy

Metabolic syndrome is linked to a mild elevation in liver aminotransferases in diabetic patients with undetectable non-alcoholic fatty liver disease by ultrasound

<p>Abstract</p> <p>Background</p> <p>Despite ongoing findings on the relationship between elevated levels of alanine and aspartate aminotransferases (ALT and AST) and metabolic syndrome (MetS), this association in diabetic patients without a known cause for liver enzymes elevation other than diabetes, per se, remains unclear. In this study, we aimed to assess the relationship between circulating liver enzymes and MetS in a relatively large sample of patients with diabetes.</p> <p>Methods</p> <p>A total of 670 diabetic patients, without known causes of hepatocellular injury, were enrolled. Patients with ultrasonographic signs of fatty liver disease were not included. Fasting blood samples were obtained and biochemical characteristics were measured. MetS was defined according to the international diabetes federation criteria.</p> <p>Results</p> <p>Serum ALT and AST were significantly higher in patients with MetS (p < 0.001). High waist circumference and low HDL-cholesterol were significantly associated with elevated ALT (OR = 2.56 and 2.0, respectively) and AST (OR = 2.23 and 2.21, respectively). ALT and AST were significantly associated with MetS (OR = 2.17 and 2.31, respectively). These associations remained significant after multiple adjustments for age, sex, BMI, diabetes duration, HbA1c and medications. There was a significant (p < 0.01) positive association between the number of the MetS features and the level of ALT or AST.</p> <p>Conclusion</p> <p>In diabetic patients without ultrasonographic evidence of fatty liver, elevated aminotransferases are independently associated with MetS. Despite negative ultrasound results in diabetic patients with MetS, the serum level of liver aminotransferases may be elevated and should be more thoroughly monitored.</p

Delirium Associated with Donepezil in a Patient with Alzheimer’s Disease: a Case Report

Donepezil, a member of the acetylcholinesterase inhibitor family, is approved for management of cognitive impairments as well as behavioral complications in patients with neurodegenerative Alzheimer's disease. Generally, donepezil is regarded as a safe medication in patients with Alzheimer’s disease although there have been reports of several minor adverse events including gastrointestinal disturbances. Herein we describe a patient with Alzheimer’s disease who demonstrated delirious behavior upon treatment with donepezil

Topical Leukocyte Function-Associated Antigen-1 (LFA-1) Antagonist Treatment (Lifitegrast) Suggest that Immune Synapsis and T cell Adhesion in Limbal Vessels is affected during DED

Purpose : The leukocyte function-associated antigen-1 (LFA-1) binds to the intercellular adhesion molecule (ICAM) family, with its principal ligand being ICAM-1. ICAM-1/LFA-1 interaction is essential for T-cell activation as well as for migration of T-cells to target tissues.The purpose of this study was to assess if LFA-1 antagonist Lifitegrast can modulate T cell activation in the dLNs, subsequently affecting T cell migration to the ocular surface during DED Methods : DED was induced in 6-8 week old wild-type mice by exposure to the controlled environmental chamber and subcutaneous injections of scopolamine. Mice were treated with topical Lifitegrast (or normal saline [NS] control) 3 times daily. To asses clinical DED severity, corneal fluorescein score (CFS) was evaluated in both groups. Corneal T cells were quantified by flow cytometry of single cell suspensions at days 10, 15 and 21. T cells from NS-treated and Lifitegrast-treated DED mice were used as donors for adoptive transfer experiments to NS-treated DED mice (recipients). Protein levels of interleukin (IL)-1b, IL-6, IL-10, IL-17, interferon (IFN)-g, and tumor necrosis factor (TNF)-awere measured in tear samples using Bio-plex Results : Lifitegrast-treatment of DED mice resulted in significant reduction of CFS and in reduced corneal T cells as compared to the NS group by flow cytometry at days 15 and 21 (p<0.05). Limbal vascular sticking efficacy (adhesion) of donor T cells from a DED mice was increased in recipient DED mice at days 15 (62±12)% and 21 (54±6)%. Donor T cells from Lifitegrast-treated (9 ±4)% were comparable to T cells from naïve donor (5±3)% mice (p<0.001). The cytokines IFN-g (75±12) pg/ml, (52±14) pg/ml, (47±15) pg/ml and IL-17 (40±14) pg/ml, (37±9) pg/ml, (69±10) pg/ml were increased, in tears of NS-treated DED mice at days 10, 15 and 21 respectively. While they were reduced in Lifitegrast-treated DED mice (22 ±8) pg/ml, (18±12) pg/ml, (12±8) pg/ml and (10±4) pg/ml, (15±9) pg/ml, (18±8) pg/ml for IFN-g and IL-17 respectively (p<0.05) Conclusions : Lifitegrast treatment results in decreased corneal T cell migration and pro-inflammatory tear cytokines in DED. Adoptive transfer experiments suggest that topical Lifitegrast may be reaching dLN and potentially affecting T cell activation and subsequent T cell adhesion to limbal vessels.Fil: Ortiz Gustavo. Tufts Medical Center; Estados UnidosFil: Jamali Arsia. Tufts Medical Center; Estados UnidosFil: Sendra, Victor German. Universidad de Buenos Aires. Facultad de Medicina. Departamento de Patología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Hamrah Pedram. Tufts Medical Center; Estados UnidosARVO Annual Meeting 2019VancouverCanadáAssociation for Research in Vision and Ophthalmolog

Local Adoptive Transfer of Plasmacytoid Dendritic Cells as a Novel Therapeutic Approach for Corneal Neovascularization

Purpose : We have recently shown that plasmacytoid dendritic cells (pDCs) exert angiostatic properties. The aim of this study is to evaluate the therapeutic efficacy of local adoptive transfer of pDCs in treating corneal neovascularization (NV). Methods : Corneas of 6-8 week-old male wildtype (WT) C57BL/6 mice underwent suture placement to induce corneal NV. Splenic GFP+ pDCs from DPE-GFP×RAG1-/- mice and WT CD11b+ myeloid cells were isolated. After trephination, 104 pDCs, CD11b+ cells, or PBS control were locally applied onto the corneas using Tisseel fibrin sealant. On day 7, corneas were stained for CD31 (vascular marker) and underwent confocal microscopy. Length of NV and the density of adoptively-transferred GFP+ pDCs were measured by ImageJ. Relative mRNA level of anti-angiogenic molecule endostatin was quantified in the corneas using qRT-PCR. ANOVA with LSD post-hoc test was used to assess statistical significance. p<0.05 was considered significant. Results : Confocal microscopy confirmed successful transfer of GFP+ pDCs to both central (452.8±39.1 cells/mm2) and peripheral corneas (435.1±52.6) on day 2 following local application of pDCs. qRT-PCR showed that local adoptive transfer of pDCs was accompanied by 4.7-fold increase in the mRNA level of anti-angiogenic molecule endostatin compared with fibrin sealant-only control (p=0.009) and 2.3-fold increase compared with adoptive transfer of CD11b+ cells (p=0.03). One-time adoptive transfer of pDCs significantly reduced NV length on day 7 following suture placement (350.1±43.4 µm), compared with transfer of CD11b+ cells (477.0±33.9 µm; p=0.004) as well as fibrin sealant-only controls (454.1±36.5 µm; p=0.01). Conclusions : Local adoptive transfer of pDCs can limit corneal NV following suture placement and may serve as a novel cell-based therapeutic approach to treat corneal NV.Fil: Arsia, Jamali. Tufts Medical Center; Estados UnidosFil: Lopez, Maria J.. Tufts Medical Center; Estados UnidosFil: Harris, Deshea L. Tufts Medical Center; Estados UnidosFil: Sendra, Victor German. Tufts Medical Center; Estados Unidos. Universidad de Buenos Aires. Facultad de Medicina. Departamento de Patología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Pondelis, Nicholas. Tufts Medical Center; Estados UnidosFil: Ortiz, Gustavo. Tufts Medical Center; Estados UnidosFil: Hamrah, Pedram. Tufts Medical Center; Estados Unidos. New England Eye Center; Estados UnidosARVO annual meeting 2019VancouverCanadáAssociation for Research in Vision and Ophthalmolog

Degeneration and Regeneration of Subbasal Corneal Nerves after Infectious Keratitis

Purpose To investigate the longitudinal alterations of subbasal corneal nerves in patients with infectious keratitis (IK) during acute phase, cessation of treatment and recovery phase by in vivo confocal microscopy (IVCM). Design Prospective, longitudinal, case-control, single-center study. Subjects Fifty-six eyes of 56 patients with the diagnosis of bacterial (n=28), fungal (n=15), and Acanthamoeba (n=13) keratitis were included in the study. Thirty eyes of 30 normal volunteers constituted the control group. Methods Corneal sensation and serial IVCM of the central cornea were performed prospectively, by using the Heidelberg Retina Tomograph 3/Rostock Cornea Module (Heidelberg Engineering, Germany). IVCM images were assessed at 3 time points: at the first visit of the patient to the cornea service, at cessation of antimicrobial treatment, and up to six months after the resolution of infection. Main outcome measures Total nerve number and length, main nerve trunks, branching and corneal sensation were assessed during the follow-up period. Results Corneal nerves were significantly reduced during the acute phase in eyes with IK compared with controls across all subgroups, with total nerve length of 5.47 ± 0.69 vs. 20.59 ± 1.06 mm/mm2; p<0.0001. At the cessation of treatment, corneal nerves in patients with IK had regenerated, including total nerve length (8.49 ± 0.94; p=0.02) and nerve branch length (4.80 ± 0.37; p=0.005). During the recovery phase, after resolution of infection, corneal nerves further regenerated, including total nerve length (12.13 ± 1.97; p=0.005), main nerve trunk length (5.80 ± 1.00; p=0.01) and nerve branch length (6.33 ± 0.76; p=0.003) as compared to the acute phase, but were still significantly lower when compared to controls (p<0.05 for all parameters). Corneal degeneration and regeneration correlated with corneal sensation (r=0.47, p=0.0009). Conclusion Patients with IK, suffering from profound loss of corneal nerves during the acute phase of infection, demonstrate an increase of corneal nerve density during the first six months after the resolution of infection. However, despite significant nerve regeneration, corneal nerve density does not fully recover and remains low as compared to controls. By providing an objective methodology to monitor corneal re-innervation, IVCM adds potentially important findings that may have implications for clinical management and surgical planning