Types and clinical presentation of stroke

Background: Stroke is one of the leading causes of mortality and morbidity worldwide. In this study, authors worked on clinical presentation and types of stroke. The two main types of strokes are ischemic and haemorrhagic. Brain infarction is caused by decrease blood flow due to either narrowing of artery or complete obstruction to blood flow owing to embolism. While haemorrhage is caused by rupture of artery or aneurysms leading to accumulation of blood in the brain parenchyma.Methods: Cross sectional study of group of patients in Nishtar hospital Multan, Pakistan who presented with variety of neurological symptoms who were subsequently diagnosed as non-traumatic stroke. All patients were subjected to a detailed history and thorough clinical examination and investigations after obtaining informed consent.Results: Of 122 patient, 66 patients were male and 56 were female. Ischemic stroke was more common: present in 76 patients as compared to 46 patients with hemorrhagic stroke. Hypertension was present in 40.9% of ischemic stroke and 27.8% of hemorrhagic strokes. Most of the patients (67.2%) had altered sensorium at presentation followed by hemiplegia in 39.3 % of patients.Conclusions: Prevalence of ischemic strokes is higher than that of haemorrhagic stroke. Hypertension is associated with both types of these strokes. Moreover, hyperglycaemia and high blood pressure are common in early phase of stroke. Vomiting in stroke favors haemorrhagic stroke

Probiotics and Fecal Transplant: An Intervention in Delaying Chronic Kidney Disease Progression?

Chronic kidney disease (CKD) is a global health challenge affecting nearly 700 million people worldwide. In the United States alone, the Medicare costs for CKD management has reached nearly USD 80 billion per year. While reversing CKD may be possible in the future, current strategies aim to slow its progression. For the most part, current management strategies have focused on employing Renin Angiotensin Aldosterone (RAS) inhibitors and optimizing blood pressure and diabetes mellitus control. Emerging data are showing that a disruption of the gut–kidney axis has a significant impact on delaying CKD progression. Recent investigations have documented promising results in using microbiota-based interventions to better manage CKD. This review will summarize the current evidence and explore future possibilities on the use of probiotics, prebiotics, synbiotics, and fecal microbial transplant to reduce CKD progression

Racial and gender-based disparities and trends in common psychiatric conditions for patients with inflammatory bowel disease in the United States: an 11-year national cross-sectional study

Background and Aim: Inflammatory bowel disease (IBD) is a chronic, debilitating disease that has been extensively studied. However, the clinical evidence remains limited regarding the racial and gender-based disparities in psychiatric illnesses in IBD patients. We aim to evaluate trends and sociodemographic disparities in psychiatric disorders in patients with IBD. Methods: The United States National Inpatient Sample (NIS) database was retrospectively investigated from 2009 to 2019 to report trends and disparities in common psychiatric comorbidities in hospitalized patients with IBD. Results: For the study period (2009–2019), the prevalence of generalized anxiety disorder (GAD) in IBD patients increased from 0.36% to 1.78%, depression increased from 9% to 13%, attention-deficit hyperactivity disorder (ADHD) increased from 0.49% to 2%, and post-traumatic stress disorder (PTSD) increased from 0.39% to 1.23% (p \u3c 0.001). The prevalence of somatization (0.004%), schizophrenia (0.43%), schizoaffective disorder (0.18%), and bipolar disorder (2.28%) showed no significant trend (p \u3e 0.05). Compared to males, females had a higher association with GAD, with an adjusted odds ratio (aOR) of 1.74 (95% CI 1.54–1.97, p \u3c 0.001), depression (aOR 1.85 [95% CI 1.79–1.92] p \u3c 0.001), bipolar disorder (aOR 1.39 [95% CI 1.29–1.51] p \u3c 0.001), PTSD (aOR 1.38 [95% CI 1.21–1.57] p \u3c 0.001), and chronic fatigue (aOR 2.91 [95% CI 1.71–4.95] p \u3c 0.001). Blacks, Hispanics, and Asian/Native Americans had a lower association with psychiatric illnesses compared to Whites (p \u3c 0.001). Conclusions: This study shows a rising prevalence of common psychiatric disorders in hospitalized patients with IBD, particularly in females. These mental illnesses were more commonly associated with Whites than Blacks, Hispanics, and Asian/Native Americans. Relevance for patients: Our findings highlight the need for effective screening and treatment protocols for psychiatric disorders in patients with IBD. It can potentially improve the quality of life and medication adherence and reduce the use of valuable healthcare resources. Prompt recognition of these mental illnesses followed by early treatment initiation can be of paramount clinical importance for sustained IBD remission

Isolated Colonic Histoplasmosis in Patients Undergoing Immunomodulator Therapy: A Systematic Review

Gastrointestinal histoplasmosis remains an inconspicuous clinicopathologic entity. It is predominantly considered a protean manifestation of disseminated disease. We hereby delineate a unique case of biopsy-proven isolated colonic histoplasmosis in a patient undergoing methotrexate therapy. Furthermore, we present the first systematic review of the MEDLINE, Google Scholar, Embase, and Scopus databases regarding isolated colonic histoplasmosis in adult patients receiving immunomodulator therapy (IMT). A total of 13 case reports (level of clinical evidence: IV) were identified. The mean age was 55.6 ± 11.1 years, with 9 (69.2%) cases reported in women. Patients with subclinical disease (5, 38.5%) were often incidentally diagnosed by screening colonoscopy. Symptomatic individuals predominantly presented with diarrhea (4, 30.8%), weight loss (3, 23.1%), and/or abdominal pain (3, 23.1%). IMT was mainly administered for liver transplant (4, 30.8%), renal transplant (4, 30.8%), and ulcerative colitis (2, 15.4%). Common colonoscopy features included colonic ulcerations (7, 53.8%), polyps or pseudopolyps (3, 23.1%), and/or mass-like lesions (3, 23.1%). Diagnosis was made by histology of colonic biopsy in 11 (84.6%) and resected specimens in 2 (15.4%) patients. Treatment consisted of a combination of amphotericin B with oral itraconazole in 6 (46.2%), oral itraconazole alone in 5 (38.5%), and amphotericin B alone in 2 (15.4%) patients. Complete clinical recovery was achieved in all patients. This article illustrates that isolated colonic involvement can be the only clinical presentation of histoplasmosis. It may masquerade as other bowel disorders, presenting diagnostic and therapeutic conundrums. Gastroenterologists should rule out colonic histoplasmosis in IMT recipients who develop unexplained colitis symptoms