Low-grade inflammation as a predictor of antidepressant and anti-inflammatory therapy response in MDD patients: A systematic review of the literature in combination with an analysis of experimental data collected in the EU-Moodinflame consortium

Low-grade inflammation plays a role not only in the pathogenesis of major depressive disorder (MDD) but probably also in the poor responsiveness to regular antidepressants. There are also indications that anti-inflammatory agents improve the outcomes of antidepressants. Aim: To study whether the presence of low-grade inflammation predicts the outcome of antidepressants, anti-inflammatory agents, or combinations thereof. Methods: We carried out a systematic review of the literature on the prediction capability of the serum levels of inflammatory compounds and/or the inflammatory state of circulating leukocytes for the outcome of antidepressant/anti-inflammatory treatment in MDD. We compared outcomes of the review with original data (collected in two limited trials carried out in the EU project MOODINFLAME) on the prediction capability of the inflammatory state of monocytes (as measured by inflammatory gene expression) for the outcome of venlafaxine, imipramine, or sertraline treatment, the latter with and without celecoxib added. Results: Collectively, the literature and original data showed that: 1) raised serum levels of pro-inflammatory compounds (in particular of CRP/IL-6) characterize an inflammatory form of MDD with poor responsiveness to predominately serotonergic agents, but a better responsiveness to antidepressant regimens with a) (add-on) noradrenergic, dopaminergic, or glutamatergic action or b) (add-on) anti-inflammatory agents such as infliximab, minocycline, o

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Ileal inflammatory fibroid polyp causing chronic ileocolic intussusception and mimicking cecal carcinoma

Inflammatory fibroid polyp (IFP) is a rare, idiopathic pseudotumorous lesion of the gastrointestinal tract. While mostly reported as solitary gastric lesions, multiple cases of small bowel IFPs are also reported. It is a documented cause of intussusception in adults. In the case reports of ileal inflammatory fibroid polyps with intussusception, an emergent presentation with small bowel obstruction has been most often described. Here we depict a case of ileal inflammatory fibroid polyp presenting with chronic intermittent ileocolic intussusception, anemia and weight loss with an endoscopic appearance mimicking necrotic cecal carcinoma

Qualitative Validation of COPD Evidenced Care Pathways in Japan, Canada, England, and Germany: Common Barriers to Optimal COPD Care

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide. A comprehensive and detailed understanding of COPD care pathways from pre-diagnosis to acute care is required to understand the common barriers to optimal COPD care across diverse health systems. METHODS: Country-specific COPD care pathways were created for four high-income countries using international recommendations and country-specific guidelines, then populated with published epidemiological, clinical, and economic data. To refine and validate the pathways, semi-structured interviews using pre-prepared discussion guides and country-specific pathway maps were held with twenty-four primary and secondary care respiratory healthcare professionals. Thematic analysis was then performed on the interview transcripts. RESULTS: The COPD care pathway showed broad consistency across the countries. Three key themes relating to barriers in optimal COPD management were identified across the countries: journey to diagnosis, treatment, and the impact of COVID-19. Common barriers included presentation to healthcare with advanced COPD, low COPD consideration, and sub-optimal acute and chronic disease management. COVID-19 has negatively impacted disease management across the pathway but presents opportunities to retain virtual consultations. Structural factors such as insurance and short duration of appointments also impacted the diagnosis and management of COPD. CONCLUSION: COPD is an important public health issue that needs urgent prioritization. The use of Evidenced Care Pathways with decision-makers can facilitate evidence-based decision making on interventions and policies to improve care and outcomes for patients and reduce unnecessary resource use and associated costs for the healthcare provider/payer

Towards Liveable Neighbourhoods by Redesigning Using Water Sensitive Design

This study was executed in Cape Town, a city that is arguably a microcosm ofcontemporary global challenges. Segregated apartheid colonial planning resulted in an atomised spatial geography. It is known that Water Sensitive Design (WSD) can regenerate urban catchments to bring multiple benefits, such as enhancing ecological health, securing water resources, increasing recreational opportunities, enhancing ecological and human health, reducing of urban heat island, mitigating floods and offering a range of economic benefits. But how can WSD spatially be integrated in an existing city setting given prevailing constraints? Located in Cape Town, the purpose of this study was to generate spatial WSD proposals that are responsive to the social inequity and informality challenges of a Global South city context. The empirical context of this study was Hangberg, a low income and informalising neighbourhood located at the edge of a biodiversity conservation area on the slopes of the Sentinel Mountain. Sandwiched between an artificial harbour and the nature reserve, the neighbourhood has limited land for expansion. In Hangberg, the above challenges are heightened, even as population increases naturally and by immigration. Hangberg neighbourhood is located in Hout Bay suburb. The history of Hout Bay suburb is centered around the Hout Bay River. Starting in the 1650s, the natural Hout Bay River Catchment was transformed through farming, lumbering and urbanisation. From the 1930s, advent of the private motorcar made scenic Hout Bay an attractive area for residential development. Hout Bay is today mainly an affluent residential suburb. The fishing, recreation and tourism industries are also important. But the river catchment and the bay are pressured by urban developed. Hangberg and Imizhamo Yethu are two low income enclaves in the otherwise affluent suburb. There have been many WSD studies in South Africa. The studies have come up with valuable fit-for-context WSD insights and solutions. But none of the studies have engaged with spatial integration of WSD solutions in a specific urban, environmental, social and legal-institutional context. The goal of this study was to create spatial WSD proposals that are responsive to prevailing contextual factors in a Global South city, including informality. The study intended to generate a set of spatially accurate WSD plans and a set of visualisations for a water sensitive precinct and neighbourhood. The study’s target was to formulate compelling and realistic proposals for water sensitive places in Hangbergand Hout Bay. This interdisciplinary study produced mutually supportive packages of knowledge from the fields of anthropology, hydrological engineering, urban planning, urban design and information systems. The study yielded the following key outcomes: (1) A hydrological model that demonstrates the flooding mitigating capacityof adding Sustainable Drainage Systems (SuDS) in the Hout Bay Catchment (2) A Water Sensitive Spatial Planning (WSSP) proposal for the Hout Bay Subdistrict of Cape Town (3) Insights into how low-income residents in Hangberg experience water, space and urban living (4) A Water Sensitive Urban Design (WSD) proposal for Hangberg neighbourhood (5) An online Decision Support Platformfor Water Sensitive Places</p