Systematic review and meta-analysis. small intestinal bacterial overgrowth in chronic pancreatitis

BACKGROUND: Evidence on small intestinal bacterial overgrowth (SIBO) in patients with chronic pancreatitis (CP) is conflicting. AIM: The purpose of this study was to perform a systematic review and meta-analysis on the prevalence of SIBO in CP and to examine the relationship of SIBO with symptoms and nutritional status. METHODS: Case-control and cross-sectional studies investigating SIBO in CP patients were analysed. The prevalence of positive tests was pooled across studies, and the rate of positivity between CP cases and controls was calculated. RESULTS: In nine studies containing 336 CP patients, the pooled prevalence of SIBO was 36% (95% confidence interval (CI) 17-60%) with considerable heterogeneity (I2 = 91%). A sensitivity analysis excluding studies employing lactulose breath test gave a pooled prevalence of 21.7% (95% CI 12.7-34.5%) with lower heterogeneity (I2 = 56%). The odds ratio for a positive test in CP vs controls was 4.1 (95% CI 1.6-10.4) (I2 = 59.7%). The relationship between symptoms and SIBO in CP patients varied across studies, and the treatment of SIBO was associated with clinical improvement. CONCLUSIONS: One-third of CP patients have SIBO, with a significantly increased risk over controls, although results are heterogeneous, and studies carry several limitations. The impact of SIBO and its treatment in CP patients deserve further investigation

Case Report: The Complexities of Managing Medications and the Importance of Deprescribing Anticholinergics in Older Adults

Potentially inappropriate anticholinergic medications (including over-the-counter products), polypharmacy, and the existence of communication barriers among members of the interprofessional team frequently contribute to clinical complexity in older adults. We present the case of a frail 86-year old female from the perspective of a community pharmacist managing outpatient medications and transitions of care. CD’s past medical history is significant for dementia, multiple falls, recurrent urinary tract infections, depression, cardiac arrhythmia, macular degeneration, chronic pain, depression, and cerebrovascular disease

National Trends in Off-Label Use of Atypical Antipsychotics in Children and Adolescents in the United States

The objectives of the study were as follows: to examine the national trend of pediatric atypical antipsychotic (AAP) use in the United States; to identify primary mental disorders associated with AAPs; to estimate the strength of independent associations between patient/provider characteristics and AAP use. Data are from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey. First, average AAP prescription rates among 4 and 18-year-old patients between 1993 and 2010 were estimated. Second, data from 2007 to 2010 were combined and analyzed to identify primary mental disorders related to AAP prescription. Third, a multivariate logistic regression model was developed having the presence of AAP prescription as the dependent variable and patient/provider characteristics as explanatory variables. Adjusted odds ratios (AORs) with associated 95% confidence intervals (CIs) were estimated. Outpatient visits including an AAP prescription among 4 to 18-year-old patients significantly increased between 1993 and 2010 in the United States, and over 65% of those visits did not have diagnoses for US Food and Drug Administration-approved AAP indications. During 2007 to 2010, the most common mental disorder was attention-deficit hyperactivity disorder, accounting for 24% of total pediatric AAP visits. Among visits with attention-deficit hyperactivity disorder diagnosis, those with Medicaid as payer (AOR 1.66, 95% CI 1.01–2.75), comorbid mental disorders (e.g., psychoses AOR 3.34, 95% CI 1.35–8.26), and multiple prescriptions (4 or more prescriptions AOR 4.48, 95% CI 2.08–9.64) were more likely to have an AAP prescription. The off-label use of AAPs in children and adolescents is prevalent in the United States. Our study raises questions about the potential misuse of AAPs in the population

Impact of Time-Varying Treatment Exposures on the Risk of Venous Thromboembolism in Multiple Myeloma

Multiple myeloma (MM) has one of the highest risks of venous thromboembolism (VTE) of all cancers due to pathologic changes and treatment-related exposures. This study assessed the one-year incidence of VTE in newly diagnosed MM and to determine the baseline and time-varying treatment-related factors associated with VTE risk in a U.S.-based cohort. MM patients were identified and age, gender, and baseline comorbidities were determined. Treatment-related exposures included thalidomide derivatives (IMIDs), proteasome inhibitors, cytotoxic chemotherapy, steroids, erythropoietin-stimulating agents (ESAs), stem cell transplants (SCT), hospitalizations, infection, and central venous catheters (CVC). Multiple statistical models were used including a baseline competing risks model, a time-varying exposure Cox proportional hazard (CPH) model, and a case-time-control analysis. The overall incidence of VTE was 107.2 per 1000 person-years with one-half of the VTEs occurring in the first 90 days. The baseline model showed that increasing age, heart failure, and hypertension were associated with one-year incidence of VTE. MM-specific IMID treatment had lower than expected associations with VTE based on prior literature. Instead, exposure to ESAs, SCT, CVC, and infection had higher associations. Based on these results, VTE risk in MM may be less straightforward than considering only chemotherapy exposures, and other treatment-related exposures should be considered to determine patient risk

An Investigation of New Medications Initiation during Ambulatory Care Visits in Patients with Dementia

Background There is currently insufficient data describing how new medications are provided to older adult ambulatory patients with dementia in the United States (US). Objectives To describe characteristics of ambulatory care visits for adults ≥ 65 years old and investigate differences in prescribing of new medications between patients with and without dementia. Methods We conducted a population-based cross-sectional study using the 2016 National Ambulatory Medical Care Survey (NAMCS) in the US. Non-perioperative ambulatory care visits of patients ≥ 65 years old with sampling weights were used to provide national estimates of visits. Baseline characteristics were compared between visits for patients with and without dementia using Pearson\u27s chi square or Student\u27s t-tests. We used multivariable logistic regression to estimate the odds of receiving a new medication. Results 218,182,131 non-perioperative ambulatory care visits of patients ≥ 65 years old were included, 2.1% of which were for patients with dementia; these patients were older on average and had more comorbidities and higher ambulatory care utilization than those without dementia. New medications were provided at 26.3% of visits for patients with dementia. After adjusting for confounders, there was no statistically significant difference in odds of a new medication being provided between visits for patients with and without dementia (odds ratio [OR], 0.555; 95% confidence interval [CI], 0.183–1.678). Differences were seen in the provision of cholinesterase inhibitors, antipsychotics, and central nervous system agents at visits for patients with dementia (p = 0.0011, \u3c 0.0001, and 0.0011 respectively). Conclusion While fewer visits for patients with dementia provided new medications compared to patients without dementia, after adjusting for confounders no significant difference were identified. Significant differences were seen in the classes of new medications provided. Further investigation is needed to evaluate new medication usage and the utility of pharmacists in the care of patients with dementia at an outpatient setting

THE QUALITY OF THE AQUATIC ENVIRONMENT IN FISH PONDS

In our country, the most widespread growth system is the semi-intensive one with growth units represented by ponds (anthropogenic ecosystems). The semi-intensive fish culture is based on the natural productivity and / or enriched by fertilization of the anthropogenic ecosystems, respectively also on the administration of supplementary food. In fact, semi-intensive cultivation involves obtaining a fish biomass with low production costs due to the use of inexpensive inputs. The productionprofile and the way of obtaining it determine the structure and duration oftheexploitation cycle within a fish farm

Placental volume in the first trimester of pregnancy evaluated by 3D ultrasound and virtual organ computer-aided analysis (vocal) as predictor for preeclampsia

Faculty of Medicine, Transilvania University of Brasov, Romania, Al VI-lea Congres Național de Obstetrică și Ginecologie cu participare internațională, 13-15 septembrie 2018, Chișinău, Republica MoldovaIntroduction: The placenta is an essential fetal organ, with multiple functions, that ensure the interchange between mother and fetus. All the changes in the normal development of the placenta are in accordance with its functions and any disturbance in the normal process of placentation can generate abnormal perinatal outcomes. Pregnancies affected by preeclampsia continue to be challenging for obstetricians since ancient times. The main reason for the occurrence of this entity is abnormal placental development and in some cases, abnormal placental volume can predict the apparition of this pathology, sooner or later during pregnancy. Objective: The aim of this study was to investigate if the placental volume measured in the first trimester by 3D ultrasound and Visual Organ-Aided Analysis (VOCAL) could be an early predictor for the apparition of hypertensive disorders, especially preeclampsia. Material and methods: This is a prospective study conducted during the period January 2017 – December 2017. The study included a number of 140 pregnant women with singleton pregnancies and with low risk for the development of preeclampsia. Placental volume was measured by 3D ultrasound between 11-14 weeks of gestation and analyzed using VOCAL software. The affected cases were divided into two categories: early-onset preeclampsia and late-onset preeclampsia, depending on the gestational age at which this hypertensive disorder was diagnosed. Results: From the total number of patients included in our study- 140 cases, only 10 women (7,14%) developed preeclampsia: 6 cases (4,28%) developed early-onset preeclampsia (EPE), and 4 cases (2,85 %) developed late-onset preeclampsia (LPE). The mean placental volume in normal pregnancies was approximately 43, 6 cm3. In the preeclampsia group, the mean placental volume of the EPE was significantly reduced than the unaffected women: 36,1 cm3. The difference between the placental volume of the women with late-onset preeclampsia and the normal women was insignificant: 40,5 cm3 vs 43, 6 cm3. Conclusion: A slightly smaller placental volume could be discovered at the 3D ultrasound examination in the first trimester at the low-risk women who will develop preeclampsia. This pathology seems to be induced by any abnormalities in the placental development, which could be identified even in the late first trimester and used as possible early predictors for developing diseases. Despite the failure to reach statistical significance, our small study revealed placental modifications that could be more refined in the future and could find a place in the preeclampsia screening for low-risk pregnancies

Comparing carriers as a support media of white-rot fungi in natural tannins removal

In the last decades, White-rot Fungi bioremediation potential has been widely investigated, providing remarkable results toward several recalcitrant molecules. However, full-scale applications based on fungi are not employed yet and little is known about their optimal operating conditions, such as (i) their ability to grow without sterile conditions, (ii) co-substrate requirements and (iii) the accurate carrier design for fungal growth. In this study, several batch tests were performed as preliminary steps to evaluate the possible design of a pilot-scale reactor based on fungal biomass to be operated under not-sterile conditions in the removal of Quebracho natural tannin. The tests were performed to verify fungal affinity, including Basidiomycetes and Ascomycetes for innovative cellulose-containing carriers compared to commonly employed PolyUrethane Foam Cubes. In particular, four fungi, including three Basidiomycetes White-rot Fungi, Bjerkandera adusta, Phanerochaete chrysosporium and Tyromyces chioneus and the Ascomycota strain Aspergillus tubingensis, were employed. As a first step, fungi were tested to evaluate their ability to attach and grow onto 12 types of innovative carriers made by High-Density PolyEthylene and containing cellulose in different percentages. Other tests were performed without sterile conditions. In particular, fungal abilities (i) to attach and grow onto two different types of support, including cellulose-containing carrier and polyurethane foam cubes and (ii) to biotransform recalcitrant molecules (Quebracho natural tannin) (iii) to grow and operate synergistically in a consortium of two fungi, were evaluated. The main parameters evaluated were soluble Chemical Oxygen Demand (sCOD) reduction and dry weight increase. Basidiomycetes showed high affinity for cellulose-containing carrierswith the highest cellulose percentage (7%) achieving full colonization and 60% coverage, in sterile conditions and not- sterile conditions, respectively. These results were associated with a Quebracho sCOD removal of 25 ± 4%, without sterility. When combined, the two selected strains, Bjerkandera adusta and Aspergillus tubingensis were able to grow on carriers and to remove up to 15 ± 4% of tannins recalcitrant sCOD. This study provides evidence of (i) Basidiomycetes high affinity for cellulose-containing carriers that could favour fungi attachment in sterile and not-sterile conditions and (ii) the feasibility of a combined use of Ascomycetes and Basidiomycetes in bioremediation

Patients’ Attitudes Toward Deprescribing and Their Experiences Communicating with Clinicians and Pharmacists

Purpose: Developing effective deprescribing interventions relies on understanding attitudes, beliefs, and communication challenges of those involved in the deprescribing decision-making process, including the patient, the primary care clinician, and the pharmacist. The objective of this study was to assess patients’ beliefs and attitudes and identify facilitators of and barriers to deprescribing. Methods: As part of a larger study, we recruited patients ⩾18years of age taking ⩾3 chronic medications. Participants were recruited from retail pharmacies associated with the University of Kentucky HealthCare system. They completed an electronic survey that included demographic information, questions about communication with their primary care clinician and pharmacists, and the revised Patients’ Attitudes Toward Deprescribing (rPATD) questionnaire. Results: Our analyses included 103 participants (n=65 identified as female and n=74 as White/Caucasian) with a mean age of 50.4years [standard deviation (SD)=15.5]. Participants reported taking an average of 8.4 daily medications (SD=6.1). Most participants reported effective communication with clinicians and pharmacists (66.9%) and expressed willingness to stop one of their medications if their clinician said it was possible (83.5%). Predictors of willingness to accept deprescribing were older age [odds ratio (OR)=2.99, 95% confidence interval (CI)=1.45–6.2], college/graduate degree (OR=55.25, 95% CI=5.74–531.4), perceiving medications as less appropriate (OR=8.99, 95% CI=1.1–73.62), and perceived effectiveness of communication with the clinician or pharmacist (OR=4.56, 95% CI=0.85–24.35). Conclusion: Adults taking ⩾3 chronic medications expressed high willingness to accept deprescribing of medications when their doctor said it was possible. Targeted strategies to facilitate communication within the patient–primary care clinician–pharmacist triad that consider patient characteristics such as age and education level may be necessary ingredients for developing successful deprescribing interventions