The effect of increasing physical activity and/or omega-3 supplementation on fatigue in inflammatory bowel disease

Objective: Fatigue is frequently reported by patients with inflammatory bowel disease (IBD), irrespective of disease activity; however, evidence regarding fatigue management is limited. This study tested the effect of individualised advice to increase physical activity and/or omega-3 fatty acids supplementation, on IBD-related fatigue. Methods: A pilot study in patients with inactive IBD, utilising a randomised controlled 2x2 factorial design (four groups) compared baseline and post-intervention fatigque scores. Study interventions: individualised exercise advice (15 minute consultation) and/or supplementation (omega-3 fatty acids, 2970mg/day) for 12 weeks. Control interventions: general health discussion and/or placebo supplement. All patients received follow-up support. Primary outcome was fatigue measured by Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) scale score; secondary outcomes included change in Inflammatory Bowel Disease-Fatigue (IBD-F) scale score. Results: From n=656 screened patients, n=74 who met the selection criteria were randomised, n=60 commenced, and n=52 completed the study. Fatigue as tThe primary outcome fatigque, measured with FACIT-F, showed slight worsening in the omega-3 supplementation group (95%CI:-8.6-(-0.7);p=0.02), and no change in the exercise advice group (p=0.38). Reduced fatigue, measured by IBD-F score, was identified in the exercise group (95%CI:-3.8-(-0.2);p=0.03). One treatment-related adverse event (musculoskeletal pain) was reported with exercise. Conclusions: Advice to increase physical activity and omega-3 supplementation, singly or in combination, were shown to be safe and generally well-tolerated. There was no evidence of exercise-related adverse effects on gut-related symptoms, and some evidence of improvement in fatigue. The slight worsening of fatigue with omega-3 supplementation is unexplained. Regular moderate to -vigorous exercise may be a self-management option in IBD-related fatigue

The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase 1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age  6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score  652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc = 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N = 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in Asia and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

Assessing fatigue in patients with inflammatory bowel disease

Fatigue in inflammatory bowel disease (IBD) has been reported to be a major issue in terms of its understanding, assessment, and management, for both patients and clinicians. This paper summarises the results of three separate but interlinked studies reporting on: health-care practitioners' perceptions of fatigue in IBD patients, an IBD fatigue patient self-assessment scale, and a checklist to assess the possible reversible factors contributing to fatigue. Health-care practitioners reported a lack of understanding of fatigue and a need for more information and education to help them to address fatigue in a constructive manner in clinical consultations. The IBD fatigue patient self-assessment questionnaire is a helpful tool to assess fatigue in a systematic manner, and provides a quantifiable score of the level of fatigue experienced by an individual. The screening checklist for IBD fatigue provides a valuable tool to identify the priorities for testing for clinically potentially reversible causes of fatigue. </jats:p

Identification and Genetic Characterization of a Novel CRF22_01A1 Recombinant Form of HIV Type 1 in Cameroon

Cameroon is a country in West Central Africa in which all four groups of HIV-1 (M, N, O, and P), some circulating recombinant forms (CRFs) and unique recombinant forms (URFs) are prevalent. The CRF22 was initially identified through a novel URF strain, 01CM53122, and later defined from two additional sequences; however, the genomic properties of CRF22 have never been demonstrated in detail. In this study, we describe the characterization of five CRF22_01A1 strains, 02CMLT72, 01CM1867LE, 01CM001BBY, 02CM3097MN, and 02CM1917LE, identified in Cameroon without apparent epidemiological links. A typical CRF22_01A1 strain contains five fragments that can be assigned to the CRF01_AE and subsubtype A1 radiations. Forty-eight percent of the genome is classified as CRF01_AE, spanning the entire region of the gag gene, part of the pol gene, and accessory genes as well as the beginning and the end of the env gene and nef gene. Fifty-two percent of the genome is subsubtype A1 including regions mostly in the pol, vif, and env genes. The five CRF22_01A1 viruses formed a deep branch outside the groups of CRF01_AE and displayed similar mosaic structure but were moderately different from the original strain of CRF22_01A1, 01CM53122. Further analysis of the 01CM53122 genome showed that this virus represents a diverse set of mosaic genomes from CRF22_01A1, including a 446-nt segment of 01CM53122 in the env region, but unlike other CRF22 strains, clustered with CRF01_AE rather than the A1 sequence, suggesting that the 01CM53122 strain is a recombinant of CRF22_01A1 and CRF01_AE