Lack of effect of treating Helicobacter pylori infection in patients with nonulcer dyspepsia. Omeprazole plus Clarithromycin and Amoxicillin Effect One Year after Treatment (OCAY) Study Group.

It is uncertain whether treatment of Helicobacter pylori infection relieves symptoms in patients with nonulcer, or functional, dyspepsia. METHODS: We conducted a double-blind, multicenter trial of patients with H. pylori infection and dyspeptic symptoms (moderate-to-very-severe pain and discomfort centered in the upper abdomen). Patients were excluded if they had a history of peptic ulcer disease or gastroesophageal reflux disease and had abnormal findings on upper endoscopy. Patients were randomly assigned to seven days of treatment with 20 mg of omeprazole twice daily, 1000 mg of amoxicillin twice daily, and 500 mg of clarithromycin twice daily or with omeprazole alone and then followed up for one year. Treatment success was defined as the absence of dyspeptic symptoms or the presence of minimal symptoms on any of the 7 days preceding the 12-month visit. RESULTS: Twenty of the 348 patients were excluded after randomization because they were not infected with H. pylori, were not treated, or had no data available. For the remaining 328 patients (164 in each group), treatment was successful for 27.4 percent of those assigned to receive omeprazole and antibiotics and 20.7 percent of those assigned to receive omeprazole alone (P=0.17; absolute difference between groups, 6.7 percent; 95 percent confidence interval, -2.6 to 16.0). After 12 months, gastritis had healed in 75.0 percent of the patients in the group given omeprazole and antibiotics and in 3.0 percent of the patients in the omeprazole group (P<0.001); the respective rates of H. pylori eradication were 79 percent and 2 percent. In the group given omeprazole and antibiotics, the rate of treatment success among patients with persistent H. pylori infection was similar to that among patients in whom the infection was eradicated (26 percent vs. 31 percent). There were no significant differences between the groups in the quality of life after treatment. CONCLUSIONS: In patients with nonulcer dyspepsia, the eradication of H. pylori infection is not likely to relieve symptoms

Moving Beyond Fulfillment: Wisdom Years Stories of Passion, Perseverance, and Productivity

Seven participants were interviewed to uncover how they remain so productive in their wisdom years, those typically marked by retirement. Participants included a leading educational psychologist, a renowned national television news anchor, a four-time national champion collegiate coach, the founder and former chief executive of Arbor Day Foundation, a university scholar turned playwright, and two female adventurers who quit their jobs, sold their possessions, and have lived a nomadic life, hiking thousands of miles throughout America. Their wisdom years stories describe how and why they shun retirement and remain productive. The article concludes with seven advice-laden conclusions for readers: (a) Do not retire, but if you do, retire to something, (b) follow your bliss, (c) work hard, (d) offset aging challenges, (e) be inspired by role models, (f) be a life-long learner, and (g) take heed of the universe conspiring

Diabetes mellitus - risk factor and potential future target for hepatic encephalopathy in patients with liver cirrhosis?

Hepatic encephalopathy (HE) is one of the major complications of cirrhosis, and its presence is associated with poor survival. Several risk factors for HE are well established, including age, history of HE, portosystemic shunts, or poorer liver function. In recent years, diabetes mellitus (DM) has emerged as another potential risk factor for the development of HE. This may be important for many patients, as the incidence of type 2 DM (T2DM) is increasing worldwide and, consequently, the incidence of NAFLD-related cirrhosis is rising simultaneously. In addition, DM is a critical factor in the progression of other liver diseases, such as alcohol-related liver disease. Thus, the number of patients with cirrhosis and comorbid T2DM will also increase. To date, the prevalence of DM already ranges between 22 - 40% in patients with cirrhosis. DM-associated factors that may influence the risk of HE include systemic inflammation, insulin resistance with increased muscle protein breakdown as well as autonomic dysfunction with prolonged intestinal transit time and small intestinal bacterial overgrowth. Currently, the evidence for an association between DM and both minimal and overt HE is weak and it seems likely that only poor glycemic control has an impact on HE risk. In addition, there are some early signs indicating that DM may impair the response of patients with HE to pharmacological therapies such as rifaximin. Thus, improvements in the management of glycemic control may be a candidate future target to reduce the risk of HE. In this concise review, we summarize the current evidence on the association between DM and HE and its potential future implications

Triple Therapy with High-Dose Proton-Pump Inhibitor, Amoxicillin, and Doxycycline Is Useless for Helicobacter pylori Eradication: A Proof-of-Concept Study

INTRODUCTION: Helicobacter pylori resistance to antibiotics is steadily increasing and multidrug-resistant strains are common and difficult to eliminate, mainly in countries where bismuth, tetracycline, furazolidone, and rifabutin are unavailable. AIM: To evaluate the efficacy and safety of a triple therapy with proton-pump inhibitor (PPI), amoxicillin, and doxycycline in patients with multidrug-resistant H. pylori. PATIENTS AND METHODS: This prospective study involved 16 patients (13 females; mean age - 50 ± 11.3 years) infected by H. pylori with known resistance to clarithromycin, metronidazole, and levofloxacin, but susceptibility to amoxicillin and tetracycline. All patients were previously submitted to upper endoscopy with gastric biopsies for H. pylori culture and susceptibility testing by Etest. Mutations in 23S rRNA and gyrA genes were determined by real-time PCR. A 10-day eradication regimen with PPI (double-standard dose b.i.d.), amoxicillin (1000 mg b.i.d.), and doxycycline (100 mg b.i.d.) was prescribed after pretreatment with PPI during 3 days. Eradication success was assessed by (13) C-urea breath test 6-10 weeks after treatment. Compliance and adverse events were determined through phone contact immediately after treatment and specific written questionnaires. RESULTS: Only one patient did not complete treatment due to adverse events. Another four patients experienced mild side effects not affecting compliance. The control (13) C-urea breath test was positive in all patients. Per-protocol and intention-to-treat eradication rates were 0%. CONCLUSIONS: Although safe, a triple-therapy protocol with high-dose PPI, amoxicillin, and doxycycline is useless for multidrug-resistant H. pylori eradication

Analyzing Microstructural Variations in Ancient Bricks: A Comparative Study Using SEM Analysis

A brick was donated to the University of Northern Iowa that was believed to have originated from Mesopotamia. However, the museum suggests the possibility it originated from Egypt. Brick structure can vary based on the raw materials used in their construction The size of the sand particles used in bricks contribute to the brick’s structural integrity. Bricks from Iran and England were analyzed for regional similarities to the unknown brick using Scanning Electron Microscopy (SEM).https://scholarworks.uni.edu/chemanaly_fa2023/1002/thumbnail.jp

Graduate Student Award Winners in Educational Psychology: What Made Them Successful?

Much is known about the factors that make some educational psychologists highly productive. Beginning nearly 25 years ago, Kiewra and colleagues began a series of six qualitative investigations to uncover the keys to scholarly success in educational psychology. The initial study (Kiewra & Creswell, 2000) investigated Richard Anderson, Richard Mayer, and Michael Pressley, who were ranked as the top scholars in a survey of educational psychologists. The second study (Patterson- Hazley & Kiewra, 2013), more than a decade later, investigated productive scholars Patricia Alexander, Richard Mayer, Dale Schunk, and Barry Zimmerman who were ranked as the top scholars in a survey of educational psychologists at that time. The third study (Flanigan et al., 2018) investigated a pre-selected cohort of productive German scholars affiliated with Ludwig Maximilian University: Frank Fischer, Hans Gruber, Heinz Mandl, and Alexander Renkl. The fourth study (Prinz et al., 2020) investigated five productive female scholars from the USA and Europe, stemming from a survey of international female scholars. They were Patricia Alexander, Carol Dweck, Jacquelynne Eccles, Mareike Kunter, and Tamara van Gog. The fifth study (Kiewra et al. 2021) investigated six recent early career award winners in educational psychology: Rebecca Collie, Logan Fiorella, Doug Lombardi, Sabina Neugebauer, Erika Patall, and Ming-Te Wang. The sixth study was a retrospective account of how educational psychologist John Glover was so productive (Kiewra & Kauffman, 2023). This series of studies found several common and critical factors related to scholarly productivity, including centers of excellence, mentorship, collaboration, research management, time management, writing, and support. What follows is a thumbnail synopsis of previous findings

Impact of thyroid disorders on the incidence of non-alcoholic fatty liver disease in Germany

Background Studies investigating a potential association between hypothyroidism and non-alcoholic fatty liver disease (NAFLD) showed conflicting results and large-scale population-based data from Germany on this topic are currently missing. Objective It was the aim of this analysis to investigate the impact of thyroid gland disorders on the prevalence of NAFLD in Germany. Methods In this case-control study, using the German disease Analyzer database (IQVIA), NAFLD patients were matched to patients without NAFLD by age, sex, index year, treating physician, diabetes mellitus type II, and obesity. The main outcome of the study was an association between thyroid gland disorders (hypothyroidism, hyperthyroidism and autoimmune thyroiditis) and incident NAFLD and was evaluated using logistic regression analyses. Results 57,483 patients with NAFLD were matched to 57,483 patients without liver disease. Mean age of the cohort was 60.3 years (±14.1) and 52.3% were men. In regression analyses, hypothyroidism (OR 1.17, 95% CI 1.10 - 1.24, p < 0.001) as well as autoimmune thyroiditis (OR 1.53, 95% CI 1.35–1.73, p < 0.001) were associated with a higher risk of NAFLD. In contrast, hyperthyroidism was associated with a lower risk of NAFLD (OR 0.85, 95% CI 0.77–0.94, p < 0.001). The effect of hypothyroidism on the prevalence of NAFLD remained significant across men (OR 1.31, 95% CI 1.15–1.48) as well as women (OR 1.12, 95% CI 1.05–1.21). Conclusion Hypothyroidism seems to be a risk factor for incident NAFLD

Incident dementia in elderly patients with nonalcoholic fatty liver disease in Germany

Dementia and NAFLD are two frequent conditions that share underlying risk factors mainly in the realm of metabolic disease. Additionally, an association between NAFLD and brain aging has been proposed. Therefore, we investigated the hypothesis if NAFLD is an independent risk factor for emerging dementia. In this population-based cohort study, elderly patients (≥ 65 years) with NAFLD diagnosed between 2000 and 2015 were matched 1:1 to a cohort without NAFLD based on ICD-10 coding in the Disease Analyzer database. Matching criteria were age, sex, physician, index year, and co-diagnoses associated with dementia. The primary outcomes of this study were all-cause dementia diagnoses, the incidence of vascular dementia, and antidementive drug prescription. A total of 22,317 patients with NAFLD were matched to 22,317 patients without NAFLD. Within 10 years of the index date, 16.0% of patients with NAFLD and 15.6% of the patients without NAFLD were diagnosed with dementia. On Cox regression analysis, there is no association between NAFLD and the incidence of all-cause dementia (HR 0.97, 95% CI 0.92–1.04), vascular dementia (HR 0.89, 95% CI 0.78–1.02), or the new prescription of antidementive therapy (HR 0.87, 95% CI 0.76–1.01). In sensitivity analyses, there was no association between NAFLD and dementia in different age-groups as well as men or women. In conclusion, in this database study of elderly patients coded with NAFLD no independent association with incident dementia was detected. Risk assessment regarding dementia in patients with NAFLD should be carried out in the same way as for metabolic burdened patients

Burden of depression and anxiety disorders per disease codes in patients with lymphoma in Germany

Purpose The aim of this study was to explore the incidence of depression and anxiety disorder diagnoses in a large German cohort of patients with Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) diagnoses in comparison to patients without cancer over a 10-year time frame. Methods Patients with HL (n=687) and NHL (n=4130) were matched to cohorts without a cancer diagnosis (n=687 and 4130) by age, sex, and yearly consultation frequency. The primary outcome of the study was the incidence of depression and anxiety disorders. The relationship between lymphoma, separated into HL and NHL, and both depression and anxiety disorders was investigated using Cox regression models. Results We compared 687 patients with HL with 687 matched non-cancer individuals and 4130 patients with NHL with 4130 matched non-cancer individuals. Within 10 years of the index date, 24.0% of patients with HL and 22.3% of patients with NHL were diagnosed with depression. Anxiety disorders were diagnosed in 6.7% and 5.3% of patients with HL and NHL, respectively. On regression analyses, HL (HR 2.30, 95% CI 1.65–3.21, p<0.001) and NHL (HR 2.09, 95% CI 1.81–2.41, p<0.001) were positively associated with incident depression. The HR for anxiety disorders was 1.64 (95% CI 1.24–2.16, p<0.001) in patients with NHL, while HL was not associated with incident anxiety disorders (HR 1.21, 95% CI 0.71–2.07, p<0.478). Conclusion Lymphoma constitutes a risk factor for emerging depression and anxiety disorders. Following the diagnosis of lymphoma, screening and strategies to prevent the occurrence of these diseases seem warranted

Proton pump inhibitor use and risk of hepatic encephalopathy : a multicentre study

Background & Aims: Data on the association between proton pump inhibitor (PPI) use and hepatic encephalopathy (HE) are conflicting, and data from multicentre studies are scarce. The aim of this study was to dissect the potential association between PPI use and minimal (MHE) and overt HE (OHE). Methods: Data from patients with cirrhosis recruited at seven centres across Europe and the US were analysed. MHE was defined by the psychometric hepatic encephalopathy score (PHES). PPI use was recorded on the day of testing with PHES. Patients were followed for OHE development and death/liver transplantation. Results: A total of 1,160 patients with a median MELD of 11 were included (Child-Pugh stages: A 49%/B 39%/C 11%). PPI use was noted in 58% of patients. Median follow-up time was 18.1 months, during which 230 (20%) developed an OHE episode, and 224 (19%) reached the composite endpoint of death/liver transplantation. In multivariable analyses, PPI use was neither associated with the presence of MHE at baseline nor OHE development during follow-up. These findings were consistent in subgroup analyses of patients with Child-Pugh A or B cirrhosis and after excluding patients with a history of OHE. PPI use was also not associated with a higher risk of OHE, neither in patients with an indication for treatment nor in patients without an indication. Conclusions: PPI use is not associated with a higher risk of HE in patients with cirrhosis. Based on these findings, at present, a prescription should not be prohibited in case of a generally accepted indication. Impact and implications: Data on the association between proton pump inhibitor (PPI) use and hepatic encephalopathy (HE) are conflicting. In this study, PPI use was not associated with a higher risk of minimal HE at baseline or overt HE during follow-up in patients with cirrhosis. Based on these findings, prescription of a PPI for a generally accepted indication should not be prohibited in patients with cirrhosis