Disability complications in inflammatory bowel disease patient in Northwest Greece

Introduction: Sexual dysfunction and restorative surgical operations in IBD patients are debilitating complications of the disease. In IBD patients, the surgical approach may be considered only after all the other means of treatment have failed, in order for the disease to be manageable; sexual dysfunction, on the other hand, may be due to psychological or biological factors. Aim: The aim of the present study was to examine all the data regarding IBD patients who were being monitored and were diagnosed with ileus and were treated surgically or not. We also reviewed the literature on the incidence of sexual dysfunction in IBD patients. Methods: Sexual dysfunction was investigated via a systematic literature review, given that there was no standardized and valid instrument for a quantitative study to take place. The retrospective quantitative study took place in patients monitored at the Gastroenterology Dept. of the University Hospital of Ioannina, Greece, and the ‘Hadzikostas’ General Hospital of Ioannina, between 1982-2015 and had been diagnosedwith ileus (n= 37). Results: Sexual dysfunction may aggravate IBD patients' quality of life, thus it may qualify as a debilitating side-effect. Being a chronic condition followed by continual relapses, itmay be exhausting for the patients and have an impact on their quality of sexual life, and their general quality of life overall. Regarding surgical operations, 66.7% of the patients diagnosed with Crohn's Disease (CD) were males, and 33.3% females. The average age of CD patients was 50.4 (20.9) years, the youngest being 27 and the oldest 86 years old, while the average age of ulcerative colitis (UC) patients was 66.8 (17.7), the youngest being 28 and the oldest 86. From our sample, 56.3% of the UC patients were men and 43.8% women. 33.3% of the patients with CD and 43.8% of those with UC had full-blown ileus which was investigated with endoscopy or surgical operation, one patient had subileus, and one toxic megacolon. From our sample, 88.4% of the patients had had no extra-intestinal surgical operations prior to the diagnosis, while 92.8% of them had had no intestinal operations at all. Moreover, 97.1% of the patients had had no extra-intestinal operations after the diagnosis, and 96.7% of them had had no intestinal operations at all. Regarding other surgical operations of the participating patients, 85.7% of CD patients had had no previous operation on the abdomen, compared to 93.8% of the UC patients. From those suffering from CD, 9.5% were submitted to endoscopy and surgery, compared to 12.5% of UC patients who had had endoscopy and then surgery. 4.8% of the CD patients had had a CT scan after the endoscopy, while 6.3% of the UC patients had had the CT scan before the endoscopy and 6.3% after it. In total, 28.6% of CD patients and 37.5% of UC patients were submitted to CT scan. Also, 23.8% of CD patients and 37.5% of UC patients were submitted to surgery. Conclusions: Sexual dysfunction and surgical operations qualify as debilitating sideeffects. More investigation and interdisciplinary management is needed.Εισαγωγή: Η σεξουαλική δυσλειτουργία και οι χειρουργικές επεμβάσεις σε ασθενείς με ΙΦΝΕ αποτελούν αναπηρικές επιπλοκές της νόσου. Στην ΙΦΝΕ, η χειρουργική προσέγγιση συνίσταται συνήθως μετά από αποτυχία όλων εκείνων των δυνατοτήτων και προσπαθειών έτσι ώστε να τεθεί η νόσος υπό έλεγχο και να μειωθούν οι επιπλοκές, ενώ η σεξουαλική δυσλειτουργία μπορεί να οφείλεται σε ψυχογενείς ή βιολογικούς παράγοντες. Σκοπός: Σκοπός της παρούσας μελέτης ήταν η διερεύνηση όλων των δεδομένων σχετικά με τους υπό παρακολούθηση ασθενείς με ΙΦΝΕ οι οποίοι προσήλθαν στο ιατρείο με διάγνωση ειλεού και αντιμετωπίστηκαν χειρουργικά ή όχι. Επίσης διερευνήθηκε βιβλιογραφικά η επίπτωση της σεξουαλικής δυσλειτουργίας σε ασθενείς με ΙΦΝΕΜεθοδολογία: Η σεξουαλική δυσλειτουργία μελετήθηκε μέσω συστηματικής ανασκόπησης δεδομένου του ότι δεν υπήρχε σταθμισμένο και έγκυρο εργαλείο για τη διενέργεια ποσοτικής μελέτης. H αναδρομική ποσοτική μελέτη δε, διεξήχθη σε ασθενείς που παρακολουθούνταν στην Πανεπιστημιακή Γαστρεντερολογική Κλινικής του Πανεπιστημιακού Νοσοκομείου Ιωαννίνων και στο Γενικό Νοσοκομείο Ιωαννίνων Χατζηκώστα, για το χρονικό διάστημα 1982-2015 και προσήλθαν με τη διάγνωση του ειλεού (n=37). Αποτελέσματα: Η σεξουαλική δυσλειτουργία επιφέρει έκπτωση στα ποιοτικά χαρακτηριστικά ζωής των ασθενών με ΙΦΝΕ και ως εκ τούτου μπορεί να χαρακτηριστεί ωςαναπηρική επιπλοκή. H χρονιότητα της ΙΦΝΕ και οι συνεχείς και δύσκολες περίοδοι έξαρσης της νόσου αποτελούν μια εξουθενωτική περίοδο για τον ασθενή με σημαντικό αντίκτυπο στην ποιότητα ζωής του και ως εκ τούτου συχνά και στη σεξουαλική του ζωή. Όσον αφορά στη διερεύνηση των χειρουργικών επεμβάσεων, από το συνολικό δείγμα της μελέτης το 66,7% των ασθενών που είχε διαγνωστεί με NK ήταν άνδρες, ενώ το 33,3% γυναίκες. Η μέση τιμή ηλικίας των ασθενών με ΝΚ ήταν 50,4 (20,9) με μικρότερη τιμή 27 ετών και μεγαλύτερή τιμή 93 ετών, ενώ η μέση τιμή ηλικίας των ασθενών με ΕΚ ήταν 66,8 (17,7) με μικρότερη τιμή 28 ετών και μεγαλύτερή τιμή 86 ετών. Αντίστοιχα, έπασχαν από EK το 56,3% των ανδρών του δείγματος και το 43,8% των γυναικών. Το 33,3% των ασθενών με ΝΚ και το 43,8% των ασθενών με ΕΚ έπασχε από πλήρη ειλεό και στουςοποίους ασθενείς έγινε περαιτέρω διερεύνηση(ενδοσκόπηση) ή αντιμετώπιση (χειρουργείο), ένας ασθενής έπασχε από ατελής ειλεό και ένας από τοξικό μεγάκολο. Το 88,4% των ασθενών δεν είχε υποστεί κανένα εξωεντερικό χειρουργείο πριν τη διάγνωση, ενώ το 92,8% αντίστοιχα δεν είχε υποβληθεί σε κανένα εντερικό χειρουργείο. Επίσης το 97,1% των ασθενών δεν είχε υποστεί κανένα εξωεντερικό χειρουργείο μετά τη διάγνωση ενώ το 96,7% αντίστοιχα δεν είχε υποβληθεί σε κανένα εντερικό χειρουργείο Σχετικά με προηγούμενα χειρουργεία των ασθενών που συμμετείχαν στη μελέτη φάνηκε ότι το 85,7% των ασθενών με ΝΚ δεν είχε πραγματοποιήσει κανένα χειρουργείο προηγουμένως στην κοιλιά, ενώ το ποσοστό αυτό για την ΕΚ έφτασε το 93,8%. Το 9,5% των ασθενών με ΝΚ πραγματοποίησε ενδοσκόπηση και χειρουργείο, ενώ το 12,5% των ασθενών με ΕΚπραγματοποίησε ενδοσκόπηση και μετά χειρουργείο. Το 4,8% των ασθενών με ΝΚ πραγματοποίησε αξονική μετά την ενδοσκόπηση, ενώ το 6,3% των ασθενών με ΕΚ πραγματοποίησε αξονική πριν την ενδοσκόπηση και το 6,3% μετά την ενδοσκόπηση. Το 28,6% των ασθενών με ΝΚ και το 37,5% των ασθενών με ΕΚ πραγματοποίησε ενδοσκόπηση . Το 23,8% των ασθενών με ΝΚ πραγματοποίησε χειρουργείο, και το 37,5% των ασθενών με ΕΚ πραγματοποίησε χειρουργείο. Συμπεράσματα: Η σεξουαλική δυσλειτουργία και οι χειρουργικές επεμβάσεις αποτελούν αναπηρικές επιπλοκές. Χρειάζονται δε σημαντική διερεύνηση και ιδιαίτερη διεπιστημονική αντιμετώπιση

Gradient 3D Printed PLA Scaffolds on Biomedical Titanium: Mechanical Evaluation and Biocompatibility

The goal of the present investigation was to find a solution to crucial engineering aspects related to the elaboration of multi-layered tissue-biomimicking composites. 3D printing technology was used to manufacture single-layered and gradient multi-layered 3D porous scaffolds made of poly-lactic acid (PLA). The scaffolds manufacturing process was optimized after adjusting key printing parameters. The scaffolds with 60 μm side length (square-shaped pores) showed increased stiffness values comparing to the other specimens. A silicone adhesive has been further used to join biomedical titanium plates, and the PLA scaffolds; in addition, titania nanotubes (TNTs were produced on the titanium for improved adhesion. The titanium-PLA scaffold single lap joints were evaluated in micro-tensile testing. The electrochemical processing of the titanium surface resulted in a 248% increase of the ultimate strength in the overlap area for dry specimens and 40% increase for specimens immersed in simulated body fluid. Finally, the biocompatibility of the produced scaffolds was evaluated with primary cell populations obtained after isolation from bone residual tissue. The manufactured scaffolds present promising features for applications in orthopedic implantology and are worth further

Exhaled nitric oxide and exhaled breath condensate pH as predictors of sputum cell counts in optimally treated asthmatic smokers

Background and objective: Smoking is thought to modify the pattern of airway inflammation. Induced sputum provides useful information on cellular phenotype in inflammatory airways disorders; however, it is time-consuming and difficult to implement in everyday clinical practice. The aim of this study was to determine whether exhaled NO (FeNO) and exhaled breath condensate (EBC) pH differed in asthmatic smokers compared with asthmatic non-smokers and healthy subjects, and to evaluate the performance of FeNO and EBC pH for predicting the cellular phenotype of induced sputum. Methods: Asthmatic smokers (n = 40) and nonsmoking asthmatic patients (n = 43) were recruited for the study. Healthy smoking (n = 30) or non-smoking (n = 30) subjects served as controls. FeNO and EBC pH were measured and all subjects underwent sputum induction for assessment of cell counts. Results: EBC pH was significantly lower in asthmatic smokers compared with non-smokers (P < 0.01). FeNO levels were also significantly lower in asthmatic smokers compared with non-smokers (P < 0.001). EBC pH was inversely associated with sputum eosinophils in both asthmatic smokers and non-smokers (P < 0.001), whereas it was inversely associated with sputum neutrophils only in asthmatic smokers (P < 0.001). FeNO was positively associated with sputum eosinophils both in asthmatic smokers and non-smokers (P < 0.001) but was not associated with sputum neutrophils. In asthmatic smokers, FeNOwas a better predictor of sputum eosinophilia, whereas EBC pH was a better predictor of sputum neutrophilia. A combination of FeNO <= 14 ppb together with EBC pH > 7.20 predicted the paucigranulocytic induced sputum phenotype. Conclusions: EBC pH and FeNO levels were significantly lower in asthmatic smokers compared with nonsmokers. Combined specific cut-off levels for FeNO and EBC pH may predict the paucigranulocytic phenotype in asthmatic smokers

Evaluation of Immature Platelet Fraction in Lower Respiratory Tract Infections: A Retrospective Study

Introduction Immature platelet fraction (IPF) is a parameter of an automated hematologic analyzer and is related to platelet size and cytoplasmic RNA content. It reflects thrombopoiesis and is often used as the marker of platelet activity. IPF has been evaluated mostly in hematologic disorders and has also been evaluated in patients with gestational hypertension, sepsis, autoimmune diseases and in hospitalised patients with neutrophilia. Platelets, asides from the maintenance of hemostasis, release inflammatory mediators that can modify leukocyte and endothelial responses to various inflammatory stimuli. Lower respiratory tract infections are the leading cause of death from infections worldwide. The role of platelets in lower respiratory tract infections has been reported in many studies. IPF, which is related to platelet activation, has not been evaluated in patients with lower respiratory tract infections. Methods The study involved patients who fulfilled the criteria of community-acquired pneumonia (CAP) and aspiration pneumonia (AP). In addition, age and sex-matched healthy controls were involved. Whole blood samples were collected from healthy controls and from the patients on admission. The mean IPF% and C-reactive protein (CRP) levels were measured in patients with CAP, in patients with AP and in healthy controls. The mean IPF% values in patients with infection were compared to mean IPF% values in healthy controls. The mean IPF% values were compared to mean CRP levels in patients with infection. Additionally, the mean IPF% values in patients that died in the first 14 days were compared to the mean IPF% values in patients that were alive. The statistical analysis of data was performed with the Statistical Package for the Social Sciences (SPSS) for Windows, Version 13.0 (SPSS Inc, Chicago, IL). Results The study population consisted of 45 patients (27 patients with CAP and 18 patients with AP), 27 males and 18 females, with a mean age of 72.11 +/- 16.4 years and 39 healthy controls, 22 males and 17 females with a mean age of 64.2 +/- 14.8 years. The mean CRP levels in patients with infection were 155.2 +/- 119.1 mg/dl. The mean IPF% value of patients with infection was 2.76 +/- 2.27 and the mean IPF% value of controls was 1.72 +/- 0.77 (p < 0.006). The IPF% value in patients with CAP was 2.55 +/- 2.02 and in patients with AP 3.07 +/- 2.64 (p = 0.595). The mean IPF% value in patients with infection had no linear correlation with CRP value in these patients (r = 0.076, p = 0.62). The mean IPF% value in all patients that died in the first 14 days was 3.75 +/- 2.44 and the mean IPF% value in all patients alive was 2.35 +/- 2.11 (p = 0.06). The mean IPF% value in patients with CAP who died in the first 14 days of hospitalisation was 5.54 +/- 3.17 and in patients with CAP who were alive was 1.87 +/- 0.72 (p = 0.06). The mean IPF% value in patients with AP who died was 2.63 +/- 0.85 and in patients with AP who were alive was 3.41 +/- 3.51 (p = 0.554). Conclusions Mean IPF% value is greater in patients with lower respiratory tract infections, including CAP and AP, compared to healthy controls. There is no linear correlation between IPF values and CRP values in patients with lower respiratory tract infections. In addition, there is a difference in mean IPF% value between patients who died in the first 14 days of hospitalisation compared to those who were alive, but not statistically significant