12 research outputs found
Abdominal pain in an adult with Type 2 diabetes: A case report
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Frequency and Severity of Cirrhotic Cardiomyopathy and Its Possible Relationship with Bacterial Endotoxemia
Background The cardiac dysfunction presented in cirrhotic patients is
already known as cirrhotic cardiomyopathy. The pathogenesis of this
entity is not fully understood. Aims The aim of this study was to
evaluate the frequency and characteristics of cirrhotic cardiomyopathy
and to investigate the possible role of bacterial endotoxemia on its
aggravation.
Methods Forty-five cirrhotics were studied by a tissue Doppler imaging
echocardiography at rest and after stress. The diagnosis of left
ventricular diastolic dysfunction was based on the latest guidelines of
the American Society of Echocardiography, whereas its severity was
defined by the E/e’av ratio. Endotoxemia was estimated by measuring the
serum levels of lipopolysaccharide-binding protein (LBP) and cytokines.
Results None of the patients had systolic dysfunction, but 17/45 (37.8
%) had a diastolic one. Patients with grade II diastolic dysfunction
had significantly longer QTc (p = 0.049), larger left atrium volume (p =
0.013), higher Brain Natriuretic Peptide levels (p = 0.007) and higher
LBP levels (p = 0.02), compared to those with normal cardiac function,
without differences in the systemic hemodynamics and the cytokines’
levels. Moreover, the severity of diastolic dysfunction as reflected by
the E/e’av. was significantly correlated with the LBP levels (p =
0.002). On the multivariate analysis, the LBP was independently
associated with the presence of diastolic dysfunction.
Conclusions Cirrhosis is commonly complicated by cardiac dysfunction.
Patients with severe cirrhotic cardiomyopathy have higher LBP levels,
which are significantly correlated with the degree of diastolic
dysfunction. Our findings support a potential role of bacterial
endotoxemia on the aggravation of cardiomyopathy in cirrhotic patients
Whipple Disease
Whipple disease (WD) is a rare disease caused by Tropheryma whipplei.
The classic profile of the patient is that of a middle-aged man
presenting with fever, chronic diarrhea, and arthralgias.
Extragastrointestinal manifestations are not rare. A high degree of
clinical suspicion for the disease is needed in atypical cases.
Trimethoprim-sulfamethoxazole is the treatment of choice. We present two
patients with WD. The first presented with melena and generalized
hyperpigmentation. The second had depression for two years before the
typical symptoms. Both hyperpigmentation and long-lasting depression
without the typical manifestations of the disease are rare. Histologic
examination of tissue biopsies was diagnostic for WD. Both patients were
treated successfully with trimethoprim-sulfamethoxazole
Optimized Sedation Improves Colonoscopy Quality Long-Term
Background. Quality monitoring and improvement is prerequisite for efficient colonoscopy. Aim. To assess the effects of increased sedation administration on colonoscopy performance. Materials and Methods. During Era 1 we prospectively measured four colonoscopy quality indicators: sedation administration, colonoscopy completion rate, adenoma detection rate, and early complications rate in three cohorts: cohort A: intention for total colonoscopy cases; cohort B: cohort A excluding bowel obstruction cases; cohort C: CRC screening-surveillance cases within cohort B. We identified deficiencies and implemented our plan to optimize sedation. We prospectively evaluated its effects in both short- (Era 2) and long-term period (Era 3). Results. We identified that sedation administration and colonoscopy completion rates were below recommended standards. After sedation optimization its use rate increased significantly (38.1% to 55.8% to 69.5%) and colonoscopy completion rate increased from 88.3% to 90.6% to 96.4% in cohort B and from 93.2% to 95.3% to 98.3% in cohort C, in Eras 1, 2, and 3, respectively. Adenoma detection rate increased in cohort C (25.9% to 30.6% to 35%) and early complications rate decreased from 3.4% to 1.9% to 0.3%. Most endoscopists increased significantly their completion rate and this was preserved long-term. Conclusion. Increased sedation administration results in long-lasting improvement of colonoscopy quality indicators
Bravo 48-hour Wireless pH Monitoring in Patients With Non-cardiac Chest Pain. Objective Gastroesophageal Reflux Disease Parameters Predict the Responses to Proton Pump Inhibitors
Background/Aims
In patients with non-cardiac chest pain (NCCP), gastroesophageal reflux
disease (GERD) is the commonest cause and ambulatory pH is of great
value in identifying these patients. However, parameters in the context
of predicting therapeutic response are still unknown. By extending the
monitoring period, we could better evaluate the best evidence for GERD
association. Our aims were (1) to compare the outcomes of 48-hour pH
monitoring to 24-hour and (2) to determine whether objective parameters
could predict the treatment success in patients with NCCP using Bravo pH
system.
Methods
Pathological esophageal acid reflux (PEAR) and positive symptom index
(SI) were calculated after 24-hour and compared to the 48-hour study.
Evidence suggestive of GERD diagnosis was considered if PEAR and/or SI
(+) were present on each different day. After pH study, all patients
received proton pump inhibitor twice a day for 4 weeks. Treatment
success was determined at the end of therapy.
Results
Thirty-two patients with NCCP participated. GERD was identified in 20
(62.5%) patients; 17 (53.1%) had PEAR, 3 (9.4%) SI (+) and 7 (22%)
both. Twelve (41%) patients exhibited PEAR values on day 1, while 17
after 2 days; a 12.1 % gain. SI (+) was found in 6 patients (18.8%) on
day 1 and in 4 more on day 2, a gain of 12.5%. Significantly higher
proportion of patients with GERD indicators showed improvement compared
to those without (90% vs 16.7%, P < 0.005).
Conclusions
In patients with NCCP, 48-hour pH measurement identified GERD as the
cause of NCCP with an increased yield by almost 12% compared to 12
hours. Objective GERD parameters could predict response to antireflux
therapy