Atrial tachycardia associated with a tachycardia-induced cardiomyopathy in a patient with systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is an autoimmune disease that involves multiple organ systems. Cardiovascular involvement in SLE is well described in the literature. Cardiac arrhythmias associated with SLE include sinus tachycardia, atrial fibrillation, and atrial ectopy or atrial tachycardia. In this report, we present the case of a patient with SLE who was found to have focal atrial tachycardia that mimicked sinus tachycardia on a 12-lead electrocardiogram (ECG). She was inappropriately treated as a case of sinus tachycardia initially. But she did not respond to the treatment and developed tachycardia-induced cardiomyopathy despite being on antiarrhythmic medications. She subsequently underwent successful radiofrequency catheter ablation and her left ventricular ejection fraction (LVEF) recovered within three months after the ablation

Analysis of the burden and economic impact of digestive diseases and investigation of research gaps and priorities in the field of digestive health in the European Region—White Book 2: Executive summary

N/

Characterization of cowpea to harvest rainwater for wheat in semiarid conditions

Aim of study: A field experiment was executed, under rainfed conditions from 2014-15 to 2017-18, to study the role of cowpea (Vigna unguiculata L.) in rainwater harvesting to enhance the wheat (Triticum aestivum L.) yield.Area of study: Rain-fed area of Pothwar region, Punjab, Pakistan.Material and methods: We designed three treatments (T1: control; T2: cowpea grown after conventional tillage and incorporated into soil to act as “green manure”; and T3: grown without any tillage practice, cut with sickle and spread as “mulch”). The effect of these treatments on soil moisture conservation was studied against conventional farmer’s practice, wherein no host crop is grown before wheat sowing.Main results: Available soil water remained highest in T2 during first three years when sufficient rainfall was received contrary to fourth year with low rainfall. The results revealed that cowpea biomass of 15.2 t/ha and 13.72 t/ha, from T2 and T3 respectively, were produced during 2015 corresponding to 213 mm rainfall. Whereas, these quantities increased to 25.69 t/ha and 24.29 t/ha during 2017 with 387 mm of rainfall. The study revealed that net income from wheat crop under T2 was Rs 13000 and Rs 9000 per hectare higher than that of control during the first two years respectively. Contrarily, net income from T2 was found negative and benefit-cost ratio reduced to 0.79 when very low rainfall was received during the last year.Research highlights: Use of cowpea as green manure gave maximum net return if sufficient rainfall is received during decomposition of cowpea and hence recommended for in-situ rainwater harvesting

5\u27-nucleotidase, oxidative stress and antioxidant status in alcohol consumers and cirrhotic patients

Uvod: Cilj istraživanja bio je izmjeriti aktivnost enzima 5\u27-nukleotidaza kod bolesnika s cirozom jetre i osoba koje uzimaju alkohol. U istraživanju se ispitivao i oksidacijski stres, antioksidansi te njihova povezanost s 5\u27-nukleotidazom. Materijali i metode: Istraživanje je provedeno u tri skupine po 25 ispitanika jednake dobi i spola: I. skupina (kontrolni ispitanici), II. skupina (osobe koje uzimaju alkohol, tj. konzumenti alkohola) i III. skupina (bolesnici s cirozom jetre). Uzorci krvi prikupljeni od ispitanika centrifugirani su kako bi se odvojila plazma za analizu 5\u27-nukleotidaze. Odvojene stanice su tri puta isprane 0,9-postotnom hladnom fiziološkom otopinom i upotrebljene za analizu glutationa, malondialdehida i superoksid-dismutaze. Rezultati: Aktivnost 5\u27-nukleotidaze u serumu bila je statistički značajno povišena kod skupine bolesnika s cirozom i skupine konzumenata alkohola. Koncentracije malondialdehida bile su također statistički značajno povišene kod bolesnika s cirozom jetre i konzumenata alkohola. Koncentracije glutationa i superoksid-dismutaze bile su statistički značajno snižene u obje skupine. Zaključak: Iz ovih rezultata može se zaključiti da je aktivnost 5\u27-nukleotidaze u serumu dosljedno viša kod bolesnika s cirozom jetre i osoba koje uzimaju alkohol. Zapažena razlika mogla bi ukazivati na opseg oštećenja jetre, oštećenja hepatobilijarnog sustava i opstrukcije jetre.Background: The present study was undertaken to determine the 5\u27-nucleotidase enzyme activity in liver cirrhotic patients and alcohol consumers. Oxidative stress, antioxidants and their association with 5\u27-nucleotidase were also investigated. Methods: The study included three groups of 25 age and sex matched subjects: group I (control), group II (alcohol consumers) and group III (cirrhotic patients). Blood samples were collected and centrifuged for separation of plasma for analysis of 5\u27-nucleotidase. Separated cells were washed thrice with 0.9% w/v cold normal saline and used for the analysis of glutathione, malondialdehyde and superoxide dismutase. Results: The activity of serum 5\u27-nucleotidase was significantly increased in both cirrhotic patients and alcohol consumers. The levels of malondialdehyde were also significantly increased in both cirrhotic patients and alcohol consumers. The levels of glutathione and superoxide dismutase were significantly decreased in both cirrhotic patients and alcohol consumers. Conclusions: Study results indicated the activity of serum 5\u27-nucleotidase to be consistently higher in cirrhotic patients and alcohol consumers. The difference recorded might be pointing to the extent of liver damage, hepatobiliary damage, and biliary stasis

Transient Elastography in Community Alcohol Services: Can It Detect Significant Liver Disease and Impact Drinking Behaviour?

Introduction: Alcohol is the leading cause of cirrhosis in Western populations. The early identification of high-risk drinkers followed by intervention is an effective way to reduce harm. We aim to assess the feasibility of integrating transient elastography (TE) into community alcohol services, and to determine its impact on modifying drinking behaviours. Method: A prospective cohort study was conducted at a community alcohol clinic in Nottingham, UK (April 2012 to March 2014). Patients (>18 years) with a primary alcohol problem were recruited. Those known to liver services or those known to have chronic liver disease were excluded. Significant liver fibrosis was defined by a liver stiffness of >8 kilopascal (kPa). Follow-up was for a minimum of six months. Data were descriptively analysed for significant differences between patients with a normal liver stiffness versus raised liver stiffness. Results: 156 patients were invited; n = 87 attended and n = 86 underwent successful TE. The majority were male (n = 53, 70.0%), and the mean age was 46.3 years (SD ± 9.8). Median liver stiffness was 6.9 kPa (range 3.1–75.0kPa). Clinically significant liver fibrosis was identified in n = 33 (38.4%), of which n = 6 were in the cirrhotic range (≥15 kPa). The baseline median self-reported alcohol intake for normal stiffness was 126 units per week (range 24–378) and in raised stiffness was 149.0 units per week (range 39.0–420.0); this difference was nonsignificant (p = 0.338). The median reduction in self-reported alcohol intake in the whole cohort was 65.0 units per week (range 27.0–88.0, p < 0.001); in the normal liver stiffness group it was 25.0 units per week (range 18.0–75.0, p = 0.154), and in the raised liver stiffness group it was 78.5 units per week (range 36.0–126.0, p < 0.001). Conclusion: The study demonstrated that transient elastography is a feasible tool to stratify clinically significant liver disease in community alcohol services. It can stimulate a change in high-risk drinking behaviour and a normal liver stiffness result does not provide false reassurance to participants

Does knowledge of liver fibrosis affect high-risk drinking behaviour (KLIFAD)? protocol for a feasibility randomised controlled trial

Introduction: Heavy drinkers in contact with alcohol services do not routinely have access to testing to establish the severity of potential liver disease. Transient elastography by FibroScan can provide this information. A recent systematic review suggested providing feedback to patients based on markers of liver injury can be an effective way to reduce harmful alcohol intake. This randomised control trial (RCT) aims to establish the feasibility of conducting a larger national trial to test the effectiveness of FibroScan advice and Alcohol Recovery Video Stories (ARVS) in changing high-risk drinking behaviour in community alcohol services common to UK practice.Methods and analysis: This feasibility trial consists of three work packages (WP). WP1: To draft a standardised script for FibroScan operators to deliver liver disease-specific advice to eligible participants having FibroScan. WP2: To create a video library of ARVS for use in the feasibility RCT (WP3). WP3: To test the feasibility of the trial design, including the FibroScan script and video stories developed in WP1 and WP2 in a one-to-one individual randomised trial in community alcohol services. Semi-structured interviews will be conducted at 6 months follow-up for qualitative evaluation. Outcomes will be measures of the feasibility of conducting a larger RCT. These outcomes will relate to: participant recruitment and follow-up, intervention delivery, including the use of the Knowledge of LIver Fibrosis Affects Drinking trial FibroScan scripts and videos, clinical outcomes, and the acceptability and experience of the intervention and trial-related procedures. Data analysis will primarily be descriptive to address the feasibility aims of the trial. All proposed analyses will be documented in a Statistical Analysis Plan.Ethics and dissemination: This trial received favourable ethical approval from the West of Scotland Research Ethics Service (WoSRES) on 20 January 2021, REC reference: 20/WS/0179. Results will be submitted for publication to a peer-reviewed journal.Trial registration number ISRCTN16922410

Characteristics of alcohol recovery narratives: Systematic review and narrative synthesis

Background and aims Narratives of recovery from alcohol misuse have been analysed in a range of research studies. This paper aims to produce a conceptual framework describing the characteristics of alcohol misuse recovery narratives that are in the research literature, to inform the development of research, policy, and practice. Methods Systematic review was conducted following PRISMA guidelines. Electronic searches of databases (Ovid MEDLINE, EMBASE, CINHAL, PsychInfo, AMED and SCOPUS), grey literature, and citation searches for included studies were conducted. Alcohol recovery narratives were defined as “first-person lived experience accounts, which includes elements of adversity, struggle, strength, success, and survival related to alcohol misuse, and refer to events or actions over a period of time”. Frameworks were synthesised using a three-stage process. Sub-group analyses were conducted on studies presenting analyses of narratives with specific genders, ages, sexualities, ethnicities, and dual diagnosis. The review was prospectively registered (PROSPERO CRD42021235176). Results 32 studies were included (29 qualitative, 3 mixed-methods, 1055 participants, age range 17-82years, 52.6% male, 46.4% female). Most were conducted in the United States (n = 15) and Europe (n = 11). No included studies analysed recovery narratives from lower income countries. Treatment settings included Alcoholic Anonymous (n = 12 studies), other formal treatment, and ‘natural recovery’. Eight principle narrative dimensions were identified (genre, identity, recovery setting, drinking trajectory, drinking behaviours, stages, spirituality and religion, and recovery experience) each with types and subtypes. All dimensions were present in most subgroups. Shame was a prominent theme for female narrators, lack of sense of belonging and spirituality were prominent for LGBTQ+ narrators, and alienation and inequality were prominent for indigenous narrators. Conclusions Review provides characteristics of alcohol recovery narratives, with implications for both research and healthcare practice. It demonstrated knowledge gaps in relation to alcohol recovery narratives of people living in lower income countries, or those who recovered outside of mainstream services

Incidence and prevalence of venous thromboembolism in chronic liver disease: a systematic review and meta-analysis

Background and Aims: Historically, bleeding was thought to be a frequent and fatal complication of liver disease. However, thrombosis due to coagulation disorders in cirrhosis remains a real risk. We aim to systematically analyse published articles to evaluate epidemiology of venous thromboembolism (VTE) in chronic liver disease (CLD). Method: Electronic search was conducted on Ovid Medline, EMBASE and Scopus from inception to November 2021 to identify studies presenting epidemiology VTE (deep vein thrombosis and pulmonary embolism) in CLD in inpatients and/or community settings. Random-effects meta-analysis was performed to determine pooled per-year cumulative incidence, incidence rate and prevalence. Heterogeneity was measured by I² test, and, potential sources of heterogeneity by meta-regression and sensitivity analysis. PROSPERO registration-CRD42021239117. Results: Twenty-nine studies comprising 19,157,018 participants were included, of which 15,2049 (0.79%) had VTE. None of included the studies were done in the community. In hospitalised patients with CLD: pooled cumulative incidence of VTE was 1.07% (95%CI 0.80,1.38) per-year, incidence rate was 157.15 (95%CI 14.74,445.29) per 10,000 person-years, and period prevalence was 1.10% (95%CI 0.85,1.38) per year. There was significant heterogeneity and publication bias. Pooled relative risk (RR) of studies reporting incidence rate was 2.11 (95%CI 1.35,3.31). CLD patients (n=1644), who did not receive pharmacological prophylaxis were at 2.78 times (95% CI 1.11, 6.98) increased risk of VTE compared to those receiving prophylaxis. Conclusion: Hospitalised patients with CLD may be at an increased risk of VTE . For every 1000 hospitalised patients with CLD ten have new, and eleven have pre-existing diagnoses of VTE per-year