Exploration of personality in the patients with the inflammatory bowel disease

Uvod/Cilj. Zapaljenske bolesti creva (ZBC) koje uključuju ulcerozni kolitis (UK) i Kronovu bolest (KB) su hronične bolesti čiji je tok pod uticajem brojnih psihosocijalnih faktora. Cilj našeg istraživanja je bio ispitivanje crta ličnosti obolelih od ZBC. Metode. Ova opservaciona studija preseka je sprovedena u Univerzitetskom kliničkom bolničkom centru "Zvezdara", Beograd, Srbija. U studiju je bilo uključeno 150 osoba obolelih od ZBC, oba pola, sa dijagnozama UK (50,7%) i KB (49,3%). Glavni kriterijumi za uključivanje su bili: starost od 18 do 65 godina i dijagnostikovani UK ili KB u fazi remisije. Za sve ispitanike su iz bolničke medicinske dokumentacije prikupljeni sociodemografski i podaci o bolesti. Procenjivanje crta ličnosti obavljeno je primenom upitnika za samoprocenu the Revised NEO Personality Inventory (NEO PI - R-Revised) i Upitnika za procenu dezintegracije (DELTA 10). Rezultati. Na nivou domena, značajne razlike između obolelih od ZBC i normativnog uzorka nađene su na Neuroticizmu (p lt 0,01) i Dezintegraciji (p lt 0,01). Na nivou faceta, u poređenju sa normativnim uzorkom, oboleli od ZBC su imali značajno više skorove na facetima Anksioznost (p lt 0,01), Asertivnost (p lt 0,01), Blaga narav (p lt 0,01) i Dužnost (p lt 0,01) i značajno niže skorove na facetima Toplina (p lt 0,01), Potraga za uzbuđenjem (p lt 0,01), Pozitivne emocije p lt 0,01), Akcija (p lt 0,01), kao i na svim facetima Dezintegracije osim Depresije, Somatoformne disregulacije i Socijalne anhedonije (p lt 0,01). Razlike između UK i KB nađene su samo na nivou faceta. Faceti koji najviše doprinose prediktivnoj snazi diskriminativne funkcije su Opšta egzekutivna disfunkcija, za kojom slede Toplina, Samodisciplina, Depresija i Manija. Zaključak. Oboleli od ZBC se po strukturi ličnosti razlikuju od opšte populacije na nivou domena i na nivou faceta. Razlike između UK i KB su nađene samo na nivou faceta. Rutinska provera crta ličnosti i rana detekcija onih ZBC bolesnika koji su u većem riziku za razvoj mentalnih poremećaja i lošeg psihosocijalnog funkcionisanja može omogućiti njihovu adekvatnu prevenciju i poboljšanje toka bolesti.Background/Aim. Inflammatory bowel diseases (IBD), which include the ulcerative colitis (UC) and the Crohn's disease (CD), are chronic diseases, the course of which is under the influence of numerous psychosocial factors. The aim of this study was the exploration of the personality traits of patients with IBD. Methods. This cross-sectional study has been conducted at the University Clinical Hospital Centre Zvezdara, Belgrade, Serbia. The study involved 150 patients suffering from IBD of both genders, out of which 50.7% and 49.3% of the patients suffering from UC and CD, respectively. The main inclusion criteria were: age 18 to 65 years and confirmed the diagnosis of UC or CD in remission. The sociodemographic and disease related data were collected from the hospital medical records. The personality traits related data were collected using the self-report forms of the Revised NEO Personality Inventory (NEO PI-R) and the inventory for the Assessment of Dysregulation (DELTA 10). Results. At the domain-level, the significant differences between IBD sample and normative sample were found in the Neuroticism (p lt 0.01) and the Disintegration (p lt 0.01). At the facet-level, the IBD sample scored significantly higher than the normative sample on Anxiety (p lt 0.01), Assertiveness (p lt 0.01), Tender-Mindedness (p lt 0.01) and Dutifulness (p lt 0.01), and the significantly lower scores on Warmth (p lt 0.01), Excitement Seeking (p lt 0.01), Positive Emotion (p lt 0.01), Actions (p lt 0.01), and on the all facets of Disintegration except Depression, Somatoform Dysregulation and Social Anhedonia (p lt 0.01). The differences between UC and CD were found only at the facet-level. The facets that adds the most predictive power to the discriminative function is the General Executive Impairment, followed by Warmth, Self-Discipline, Depression and Mania. Conclusion. The IBD patients showed to differ from the general population in terms of basic personality structure at the domain-level, and at the facet-level. The differences between the UC and CD patients can be found only at the facet-level. Screening of the personality traits and early detection of the IBD patients who are at a greater risk of mental disorders and bad psychosocial functioning can enable their adequate prevention and improve the course of the disease

Utjecaj intraabdominalnog tlaka na osnovne vitalne funkcije i ishod liječenja

The purpose of the study was to point to the importance of measuring intra-abdominal pressure (IAP) and of early recognition of the consequences of increased IAP on basic vital functions. Measurement of IAP via urinary bladder was conducted every 12 hours in 70 surgical patients with acute abdominal syndromes not previously operated on. Based on the measured IAP values, all patients were divided into groups of patients with normal IAP values (n=20) and patients with increased IAP values (n=50) . Vital functions and basic laboratory analysis were monitored and the values obtained were compared with IAP in both patient groups. A statistically significant difference was found in body weight, body mass index, urine output, creatinine, urea, heart rate, partial pressure of oxygen (PaO2) and partial pressure of carbon dioxide (PaCO2) between patients with normal and increased IAP values. The increase in IAP values was found to be associated with an increase in PaCO2, respiratory rate, peak inspiratory pressure, central venous pressure, heart rate, Acute Physiology, Age and Chronic Health Evaluation II score, mortality rate, creatinine and urea values, and number of days of treatment in the intensive care unit. At the same time, the values of PaO2, blood oxygen saturation, diuresis and abdominal perfusion pressure were declining. IAP measurement is an old, cost-effective, reliable technique that is easy to perform and should be applied in all high risk patients.Cilj studije bio je ukazati na značenje mjerenja intraabdominalnog tlaka (intra-abdominal pressure, IAP) i ranog prepoznavanja promjena osnovnih vitalnih funkcija, koje su posljedica povećanja IAP. Mjerenje IAP je provedeno kroz mokraćni mjehur svakih 12 sati kod 70 bolesnika s akutnim abdominalnim sindromom koji nisu prethodno operirani. Na osnovi izmjerenih vrijednosti IAP bolesnici su podijeljeni u skupinu s normalnim vrijednostima IAP (n=20) i skupinu s povećanim vrijednostima (n=50). Praćenjem osnovnih vitalnih funkcija i laboratorijskih analiza dobivene vrijednosti uspoređivane su u odnosu na IAP u objema skupinama bolesnika. Statistički značajna razlika između bolesnika s normalnim i onih s povišenim IAP utvrđena je za tjelesnu težinu, indeks tjelesne mase, diurezu, vrijednosti kreatinina, ureju, srčanu frekvenciju, parcijalni tlak kisika (PaO2) i parcijalni tlak ugljičnog dioksida (PaCO2). Također je zapaženo da su s porastom IAP rasle i vrijednosti PaCO2, broja respiracija, vršnog inspiracijskog tlaka, centralnog venskog tlaka, srčane frekvencije, akutna fi zio loška, starosna i kronična evaluacija zdravlja II (Acute Physiology, Age and Chronic Health Evaluation, APACHE), stopa smrtnosti, vrijednosti ureje i kreatinina te broj dana liječenja u jedinici intenzivnog liječenja, dok su vrijednosti PaO2, zasićenje hemoglobina kisikom, diureza i abdominalni perfuzijski tlak bili u opadanju. Mjerenje intraabdominalnog tlaka je stara, jeftina, pouzdana metoda, jednostavna za izvođenje kod svih visoko rizičnih bolesnika

Clinical and pathological tools for identifying microsatellite instability in colorectal cancer

Aim To assess practical accuracy of revised Bethesda criteria (BGrev), pathological predictive model (MsPath), and histopathological parameters for detection of high-frequency of microsatellite instability (MSI-H) phenotype in patients with colorectal carcinoma (CRC). Method Tumors from 150 patients with CRC were analyzed for MSI using a fluorescence-based pentaplex polymerase chain reaction technique. For all patients, we evaluated age, sex, family history of cancer, localization, tumor differentiation, mucin production, lymphocytic infiltration (TIL), and Union for International Cancer Control stage. Patients were classified according to the BGrev, and the groups were compared. The utility of the BGrev, MsPath, and clinical and histopathological parameters for predicting microsatellite tumor status were assessed by univariate logistic regression analysis and by calculating the sensitivity, specificity, and positive (PPV) and negative (NPV) predictive values. Results Fifteen out of 45 patients who met and 4 of 105 patients who did not meet the BGrev criteria had MSI-H CRC. Sensitivity, specificity, PPV, and NPV for BGrev were 78.9%, 77%, 30%, and 70%, respectively. MSI histology (the third BGrev criterion without age limit) was as sensitive as BGrev, but more specific. MsPath model was more sensitive than BGrev (86%), with similar specificity. Any BGrev criterion fulfillment, mucinous differentiation, and right-sided CRC were singled out as independent factors to identify MSI-H colorectal cancer. Conclusion The BGrev, MsPath model, and MSI histology are useful tools for selecting patients for MSI testing

Clinical and pathological tools for identifying microsatellite instability in colorectal cancer

Aim To assess practical accuracy of revised Bethesda criteria (BGrev), pathological predictive model (MsPath), and histopathological parameters for detection of high-frequency of microsatellite instability (MSI-H) phenotype in patients with colorectal carcinoma (CRC). Method Tumors from 150 patients with CRC were analyzed for MSI using a fluorescence-based pentaplex polymerase chain reaction technique. For all patients, we evaluated age, sex, family history of cancer, localization, tumor differentiation, mucin production, lymphocytic infiltration (TIL), and Union for International Cancer Control stage. Patients were classified according to the BGrev, and the groups were compared. The utility of the BGrev, MsPath, and clinical and histopathological parameters for predicting microsatellite tumor status were assessed by univariate logistic regression analysis and by calculating the sensitivity, specificity, and positive (PPV) and negative (NPV) predictive values. Results Fifteen out of 45 patients who met and 4 of 105 patients who did not meet the BGrev criteria had MSI-H CRC. Sensitivity, specificity, PPV, and NPV for BGrev were 78.9%, 77%, 30%, and 70%, respectively. MSI histology (the third BGrev criterion without age limit) was as sensitive as BGrev, but more specific. MsPath model was more sensitive than BGrev (86%), with similar specificity. Any BGrev criterion fulfillment, mucinous differentiation, and right-sided CRC were singled out as independent factors to identify MSI-H colorectal cancer. Conclusion The BGrev, MsPath model, and MSI histology are useful tools for selecting patients for MSI testing

The impact of synbiotic treatment on the levels of gut-derived uremic zoxins, inflammation, and gut microbiome of chronic kidney disease patients - a randomized trial

ObjectiveAltering dysbiotic gut flora through synbiotic supplementation has recently been recognized as a potential treatment strategy to reduce the levels of gut-derived uremic toxins and decrease inflammation. Assessing its efficacy and safety has been the main goal of our randomized, double-blind, placebo-controlled study.MethodsA total of 34 nondialyzed chronic kidney disease patients, aged ≥18 years, with an estimated glomerular filtration rate between 15 and 45 mL/minute, were randomized either to an intervention group (n = 17), receiving synbiotic (Lactobacillus acidophilus, Lactobacillus casei, and Bifidobacterium lactis, 32 billion colony forming units per day plus 3.2 g of inulin), or control group (n = 17), receiving placebo during 12 weeks. The impact of treatment on the dynamic of serum levels of gut-derived uremic toxins, total serum indoxyl sulfate, p-cresyl sulfate, and trimethylamine N-oxide, was defined as the primary outcome of the study. Secondary outcomes included changes in the stool microbiome, serum interleukin-6 levels, high-sensitivity C-reactive protein, estimated glomerular filtration rate, albuminuria, diet, gastrointestinal symptom dynamics, and safety. Serum levels of uremic toxins were determined using ultraperformance liquid chromatography. The stool microbiome analysis was performed using the 16S ribosomal ribonucleic acid gene sequencing approach.ResultsSynbiotic treatment significantly modified gut microbiome with Bifidobacteria, Lactobacillus, and Subdoligranulum genera enrichment and consequently reduced serum level of indoxyl sulfate (ΔIS –21.5% vs. 5.3%, P < .001), improved estimated glomerular filtration rate (ΔeGFR 12% vs. 8%, P = .029), and decreased level of high-sensitivity C-reactive protein (–39.5 vs. –8.5%, P < .001) in treated patients. Two patients of the intervention arm complained of increased flatulence. No other safety issues were noted.ConclusionSynbiotics could be available, safe, and an effective therapeutic strategy we could use in daily practice in order to decrease levels of uremic toxins and microinflammation in chronic kidney disease patients

Impact of safety-related dose reductions or discontinuations on sustained virologic response in HCV-infected patients: Results from the GUARD-C Cohort

BACKGROUND: Despite the introduction of direct-acting antiviral agents for chronic hepatitis C virus (HCV) infection, peginterferon alfa/ribavirin remains relevant in many resource-constrained settings. The non-randomized GUARD-C cohort investigated baseline predictors of safety-related dose reductions or discontinuations (sr-RD) and their impact on sustained virologic response (SVR) in patients receiving peginterferon alfa/ribavirin in routine practice. METHODS: A total of 3181 HCV-mono-infected treatment-naive patients were assigned to 24 or 48 weeks of peginterferon alfa/ribavirin by their physician. Patients were categorized by time-to-first sr-RD (Week 4/12). Detailed analyses of the impact of sr-RD on SVR24 (HCV RNA <50 IU/mL) were conducted in 951 Caucasian, noncirrhotic genotype (G)1 patients assigned to peginterferon alfa-2a/ribavirin for 48 weeks. The probability of SVR24 was identified by a baseline scoring system (range: 0-9 points) on which scores of 5 to 9 and <5 represent high and low probability of SVR24, respectively. RESULTS: SVR24 rates were 46.1% (754/1634), 77.1% (279/362), 68.0% (514/756), and 51.3% (203/396), respectively, in G1, 2, 3, and 4 patients. Overall, 16.9% and 21.8% patients experienced 651 sr-RD for peginterferon alfa and ribavirin, respectively. Among Caucasian noncirrhotic G1 patients: female sex, lower body mass index, pre-existing cardiovascular/pulmonary disease, and low hematological indices were prognostic factors of sr-RD; SVR24 was lower in patients with 651 vs. no sr-RD by Week 4 (37.9% vs. 54.4%; P = 0.0046) and Week 12 (41.7% vs. 55.3%; P = 0.0016); sr-RD by Week 4/12 significantly reduced SVR24 in patients with scores <5 but not 655. CONCLUSIONS: In conclusion, sr-RD to peginterferon alfa-2a/ribavirin significantly impacts on SVR24 rates in treatment-naive G1 noncirrhotic Caucasian patients. Baseline characteristics can help select patients with a high probability of SVR24 and a low probability of sr-RD with peginterferon alfa-2a/ribavirin

Obeticholic acid for the treatment of non-alcoholic steatohepatitis: interim analysis from a multicentre, randomised, placebo-controlled phase 3 trial

Background Non-alcoholic steatohepatitis (NASH) is a common type of chronic liver disease that can lead to cirrhosis. Obeticholic acid, a farnesoid X receptor agonist, has been shown to improve the histological features of NASH. Here we report results from a planned interim analysis of an ongoing, phase 3 study of obeticholic acid for NASH. Methods In this multicentre, randomised, double-blind, placebo-controlled study, adult patients with definite NASH,non-alcoholic fatty liver disease (NAFLD) activity score of at least 4, and fibrosis stages F2–F3, or F1 with at least oneaccompanying comorbidity, were randomly assigned using an interactive web response system in a 1:1:1 ratio to receive oral placebo, obeticholic acid 10 mg, or obeticholic acid 25 mg daily. Patients were excluded if cirrhosis, other chronic liver disease, elevated alcohol consumption, or confounding conditions were present. The primary endpointsfor the month-18 interim analysis were fibrosis improvement (≥1 stage) with no worsening of NASH, or NASH resolution with no worsening of fibrosis, with the study considered successful if either primary endpoint was met. Primary analyses were done by intention to treat, in patients with fibrosis stage F2–F3 who received at least one dose of treatment and reached, or would have reached, the month 18 visit by the prespecified interim analysis cutoff date. The study also evaluated other histological and biochemical markers of NASH and fibrosis, and safety. This study is ongoing, and registered with ClinicalTrials.gov, NCT02548351, and EudraCT, 20150-025601-6. Findings Between Dec 9, 2015, and Oct 26, 2018, 1968 patients with stage F1–F3 fibrosis were enrolled and received at least one dose of study treatment; 931 patients with stage F2–F3 fibrosis were included in the primary analysis (311 in the placebo group, 312 in the obeticholic acid 10 mg group, and 308 in the obeticholic acid 25 mg group). The fibrosis improvement endpoint was achieved by 37 (12%) patients in the placebo group, 55 (18%) in the obeticholic acid 10 mg group (p=0·045), and 71 (23%) in the obeticholic acid 25 mg group (p=0·0002). The NASH resolution endpoint was not met (25 [8%] patients in the placebo group, 35 [11%] in the obeticholic acid 10 mg group [p=0·18], and 36 [12%] in the obeticholic acid 25 mg group [p=0·13]). In the safety population (1968 patients with fibrosis stages F1–F3), the most common adverse event was pruritus (123 [19%] in the placebo group, 183 [28%] in the obeticholic acid 10 mg group, and 336 [51%] in the obeticholic acid 25 mg group); incidence was generally mild to moderate in severity. The overall safety profile was similar to that in previous studies, and incidence of serious adverse events was similar across treatment groups (75 [11%] patients in the placebo group, 72 [11%] in the obeticholic acid 10 mg group, and 93 [14%] in the obeticholic acid 25 mg group). Interpretation Obeticholic acid 25 mg significantly improved fibrosis and key components of NASH disease activity among patients with NASH. The results from this planned interim analysis show clinically significant histological improvement that is reasonably likely to predict clinical benefit. This study is ongoing to assess clinical outcomes

Splenomegaly and thrombocytopenia in patients with liver cirrhosis

Backgroud/Aim. Splenomegaly is a frequent finding in patients with liver cirrhosis and portal hypertension and may cause hypersplenism. The occurrence of thrombocytopenia in those patients can be considered as an event with multiple etiologies. Two mechanisms may act alone or synergistically with splenic sequestration. One is central which involves either myelosuppression because of hepatitis viruses or the toxic effects of alcohol abuse on the bone marrow. The second one involves the presence of antibodies against platelets. It also depends upon the stage and etiology of liver disease. The aim of the study was to investigate a correlation between the platelet count and spleen size and the risk factors for thrombocytopenia in patients with liver cirrhosis. Methods. We studied 40 patients with decompensated liver cirrhosis who were hospitalized in the Department of Gastroenterohepatology. The liver function was graded according to Child Pugh score. Spleen size was defined ultrasonografically on the basis of craniocaudal length. Suspicion of portal hypertension was present when longitudinal spleen length was more than 11 cm. Thrombocytopenia was determined by platelet count under 150 000/mL. Results. We did not find any significant correlation between hepatic dysfunction and spleen size (p = 0.9), and between hepatic dysfunction and thrombocytopenia (p = 0.17). Our study did not find any significant correlation between spleen size and peripheral platelet count (p = 0.5), but we found a significant correlation between thrombocytopenia and etiology of cirrhosis - decreased platelet count was more common among patients with cirrhosis of alcoholic etiology than in other etiologies of cirrhosis (p = 0.001). Conclusion. According to our study, liver cirrhosis, portal hypertension and thrombocytopenia could be present even in the absence of enlarged spleen suggesting the involvement of other mechanisms of decreasing platelet account