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Alexandru BA, Rat LA, Moldovan AF, Mihancea P, Mariș L. An Open-Label Trial Study of Quality-of-Life Assessment in Irritable Bowel Syndrome and Their Treatment. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58060763. [PMID: 35744026 PMCID: PMC9230795 DOI: 10.3390/medicina58060763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/31/2022] [Accepted: 06/03/2022] [Indexed: 11/16/2022]
Abstract
Background and objectives: Irritable bowel syndrome (IBS) does not only have a complex pathophysiological evolution with central and peripheral mechanisms. This study aimed to monitor the neuropsychiatric part of IBS and its management, following the quality of life of patients with IBS. Materials and Methods: Participants numbering 145 were investigated in this study for 6 months and were divided into four groups, namely the control group with a symptomatic period of less than 6 months (n = 34), the group with irritable bowel syndrome (IBS; n = 58), IBS and neuropsychiatric treatment (n = 32), and IBS with probiotic treatment (n = 22). Clinical and paraclinical analyses as well as quality of life were monitored by domestic and international psychological questionnaires. Results: It was observed that, in patients with pro-longed symptoms, neuropsychiatric impairment occurred more frequently, and both clinical and paraclinical analyses improved significantly (p < 0.05) more so in those with complex allopathic treatment and in those with probiotic treatment. There were no significant differences between the two research groups. Conclusions: It has been shown that the neuropsychological component of IBS plays an important role in its treatment, and modern probation therapy can achieve similar results to those of neuropsychiatry. This also requires further studies to ensure the best combination in the approach to IBS.
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Affiliation(s)
- Bogdana Ariana Alexandru
- Faculty of Medicine and Pharmacy, Medicine Department, University of Oradea, 410068 Oradea, Romania; (B.A.A.); (A.F.M.)
| | - Lavinia Alina Rat
- Faculty of Medicine and Pharmacy, Doctoral School, University of Oradea, 1 December Square, 410068 Oradea, Romania; (L.A.R.); (P.M.)
| | - Andrada Florina Moldovan
- Faculty of Medicine and Pharmacy, Medicine Department, University of Oradea, 410068 Oradea, Romania; (B.A.A.); (A.F.M.)
| | - Petru Mihancea
- Faculty of Medicine and Pharmacy, Doctoral School, University of Oradea, 1 December Square, 410068 Oradea, Romania; (L.A.R.); (P.M.)
| | - Lavinia Mariș
- Faculty of Medicine and Pharmacy, Medicine Department, University of Oradea, 410068 Oradea, Romania; (B.A.A.); (A.F.M.)
- Correspondence: ; Tel.: +40-769627181
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Nemirovsky A, Ilan K, Lerner L, Cohen-Lavi L, Schwartz D, Goren G, Sergienko R, Greenberg D, Slonim-Nevo V, Sarid O, Friger M, Regev S, Odes S, Hertz T, Monsonego A. Brain-immune axis regulation is responsive to cognitive behavioral therapy and mindfulness intervention: Observations from a randomized controlled trial in patients with Crohn's disease. Brain Behav Immun Health 2022; 19:100407. [PMID: 35024638 PMCID: PMC8728050 DOI: 10.1016/j.bbih.2021.100407] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 12/11/2021] [Indexed: 02/08/2023] Open
Abstract
Background and aims Crohn's disease (CD) is a chronic inflammatory bowel disease associated with psychological stress that is regulated primarily by the hypothalamus-pituitary-adrenal (HPA) axis. Here, we determined whether the psychological characteristics of CD patients associate with their inflammatory state, and whether a 3-month trial of cognitive-behavioral and mindfulness-based stress reduction (COBMINDEX) impacts their inflammatory process. Methods Circulating inflammatory markers and a wide range of psychological parameters related to stress and well-being were measured in CD patients before and after COBMINDEX. Inflammatory markers in CD patients were also compared to age- and sex-matched healthy controls (HCs). Results CD patients exhibited increased peripheral low-grade inflammation compared with HCs, demonstrated by interconnected inflammatory modules represented by IL-6, TNFα, IL-17, MCP-1 and IL-18. Notably, higher IL-18 levels correlated with higher score of stress and a lower score of wellbeing in CD patients. COBMINDEX was accompanied by changes in inflammatory markers that coincided with changes in cortisol: changes in serum levels of cortisol correlated positively with those of IL-10 and IFNα and negatively with those of MCP-1. Furthermore, inflammatory markers of CD patients at baseline predicted COBMINDEX efficacy, as higher levels of distinct cytokines and cortisol at baseline, correlated negatively with changes in disease activity (by Harvey-Bradshaw Index) and psychological distress (global severity index measure) following COBMINDEX. Conclusion CD patients have a characteristic immunological profile that correlates with psychological stress, and disease severity. We suggest that COBMINDEX induces stress resilience in CD patients, which impacts their well-being, and their disease-associated inflammatory process. Patients with Crohn's disease exhibit distinct inflammatory and psychological modules. IL-18 correlates with clinical and psychological features of patients with Crohn's disease. COBMINDEX treatment strengthens resilience and recovers stress-induced inflammation among Crohn's disease patients. Both inflammatory and psychological measures predict COBMINDEX efficacy.
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Affiliation(s)
- Anna Nemirovsky
- The Shraga Segal Department of Microbiology, Immunology, and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, 8410501, Israel.,The National Institute of Biotechnology in the Negev, Zlotowski Neuroscience Center, and Regenerative Medicine and Stem Cell Research Center, Ben-Gurion University of the Negev, Beer-Sheva, 8410501, Israel
| | - Karny Ilan
- The Shraga Segal Department of Microbiology, Immunology, and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, 8410501, Israel
| | - Livnat Lerner
- The Shraga Segal Department of Microbiology, Immunology, and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, 8410501, Israel
| | - Liel Cohen-Lavi
- The National Institute of Biotechnology in the Negev, Zlotowski Neuroscience Center, and Regenerative Medicine and Stem Cell Research Center, Ben-Gurion University of the Negev, Beer-Sheva, 8410501, Israel.,Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Beer-Sheva, 8410501, Israel
| | - Doron Schwartz
- Dept. of Gastroenterology and Hepatology, Soroka Medical Center, and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, 8410501, Israel
| | - Ganit Goren
- Spitzer Department of Social Work Ben-Gurion University of the Negev, Beer Sheva, 8410501, Israel
| | - Ruslan Sergienko
- Department of Public Health, Ben-Gurion University of the Negev, Beer Sheva, 8410501, Israel
| | - Dan Greenberg
- Department of Health Systems Management, School of Public Health, Guilford Glazer Faculty of Business and Management, Ben-Gurion University of the Negev, Beer Sheva, 8410501, Israel
| | - Vered Slonim-Nevo
- Spitzer Department of Social Work Ben-Gurion University of the Negev, Beer Sheva, 8410501, Israel
| | - Orly Sarid
- Spitzer Department of Social Work Ben-Gurion University of the Negev, Beer Sheva, 8410501, Israel
| | - Michael Friger
- Department of Public Health, Ben-Gurion University of the Negev, Beer Sheva, 8410501, Israel
| | - Shirley Regev
- Spitzer Department of Social Work Ben-Gurion University of the Negev, Beer Sheva, 8410501, Israel
| | - Shmuel Odes
- Dept. of Gastroenterology and Hepatology, Soroka Medical Center, and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, 8410501, Israel
| | - Tomer Hertz
- The Shraga Segal Department of Microbiology, Immunology, and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, 8410501, Israel.,The National Institute of Biotechnology in the Negev, Zlotowski Neuroscience Center, and Regenerative Medicine and Stem Cell Research Center, Ben-Gurion University of the Negev, Beer-Sheva, 8410501, Israel.,Vaccine and Infectious Disease Division, Fred Hutch Cancer Research Center, Seattle, WA, USA
| | - Alon Monsonego
- The Shraga Segal Department of Microbiology, Immunology, and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, 8410501, Israel.,The National Institute of Biotechnology in the Negev, Zlotowski Neuroscience Center, and Regenerative Medicine and Stem Cell Research Center, Ben-Gurion University of the Negev, Beer-Sheva, 8410501, Israel
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Risk Factors Associated with Recurrent Clostridioides difficile Infection. Healthcare (Basel) 2020; 8:healthcare8030352. [PMID: 32967323 PMCID: PMC7551610 DOI: 10.3390/healthcare8030352] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/16/2020] [Accepted: 09/18/2020] [Indexed: 12/14/2022] Open
Abstract
Clostridioides difficile (CD) is responsible for nosocomial diarrhea syndrome with possible severe progression. Recurrence of the disease induces higher health system costs, as well as exposes patients to additional health risks. Patients with recurrence of this disease are difficult to identify, so the purpose of this study is to quantify various demographic, clinical, and treatment factors that could prevent further progression to recurrence of the disease. In the period 2018-2019, about 195 patients were diagnosed with more than one episode of CDI in the three months following the first episode. The recurrence rate for CDI was 53.84% (60.95% for one episode and 39.05% for multiple episodes). Most commonly afflicted were 60-69-year-old patients, or those with higher Charlson Comorbidity Index (CCI). Multiple analyses associated cardiovascular (odds ratios (OR) = 3.02, 95% confidence intervals (CI) = 1.23-7.39, p = 0.015), digestive (OR = 3.58, 95% CI = 1.01-12.63, p = 0.047), dementia (OR = 3.26, 95% CI = 1.26-8.41, p = 0.014), immunosuppressive (OR = 3.88, 95% CI = 1.34-11.21, p = 0.012) comorbidities with recurrences. Risk factor identification in the first episode of CDI could lead to the implementation of treatment strategies to improve the patients' quality of life affected by this disease.
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