Effectiveness of Two Dietary Approaches on the Quality of Life and Gastrointestinal Symptoms of Individuals with Irritable Bowel Syndrome

To evaluate the effectiveness of a low FODMAP (fermentable oligosaccharides, monosaccharaides, disaccharides and polyols) diet in the relief of symptoms and an improvement of the quality of life in individuals with irritable bowel syndrome in comparison to a standard diet according to the British Dietetic Association's guidelines. A non-randomized clinical trial of adult patients with IBS was compared two diet interventions. An assessment of symptoms, quality of life, and nutritional status was performed before and after the four-week mark of intervention. Individuals from the Low FODMAP Diet (LFD) group were evaluated on a third moment, after the controlled reintroduction of FODMAPs. A total of 70 individuals were divided in two groups: Low FODMAP Diet (LFD; n = 47) and Standard Diet (SD; n = 23). 57 individuals completed the four-week intervention (LFD; n = 39; SD; n = 18). At the completion of four weeks, the symptoms improved in both groups (LFD: p < 0.01; DC: p < 0.05) but LFD led to a higher relief (p < 0.05), primarily with respect to abdominal pain and diarrhoea. Quality of life improved significantly in both groups, with no significant differences between SD vs LFD (p > 0.05). In the LFD group, the relief of symptoms observed at the four-week mark remained constant after reintroduction of FODMAPs. Both interventions seem to be effective for the relief of symptoms and quality of life, however LFD had higher effectiveness in the former. The results with LFD suggest it can be a preferred approach in individuals with diarrhoeal profile.

One year of Lamivudine therapy for portuguese patients with chronic hepatitis B

OBJECTIVE

To assess the efficacy of lamivudine treatment on hepatitis B e antigen (HBeAg) and/or hepatitis B surface antigen (HBsAg) seroconversion, on other virological and serological markers of response including hepatitis B virus (HBV) DNA and serum aminotransferases, and the safety of lamivudine treatment in hepatitis B patients.

PATIENTS

This phase III open-label study evaluated the virological and biochemical response to lamivudine in 70 Portuguese patients with HBeAg positive chronic hepatitis B. Patients were treated with lamivudine 100mg once daily for 12 months.

METHODS

Antiviral activity was assessed by measuring alanine aminotransferase (ALT)/aspartate aminotransferase (AST) levels at all protocol visits, and hepatitis B serology and HBV DNA were performed at baseline and at month 12 visits. Evaluation of safety and tolerance was based on clinical adverse events and laboratory analyses.

RESULTS

The primary endpoint was virological response at month 12, defined as loss of detectable HBeAg from serum with a reduction of HBV DNA to undetectable levels, and this was observed in 19/69 (27.5%) of patients. Almost half of the patients were HBV DNA negative by this time. Mean ALT values decreased steadily during treatment and by 12 months 61% of patients had values within the normal range. HBeAg seroconversion (HBeAg negative, HBeAb positive) was achieved in 27.9% of patients by 12 months, although all patients remained HBsAg positive.

CONCLUSION

Lamivudine was well tolerated and the incidence of adverse events was similar to those reported in previous studies. Lamivudine treatment resulted in virological and biochemical improvements in HBeAg positive chronic hepatitis B patients, with HBeAg seroconversion in one-third of patients.

Prediction models for Arabica coffee beverage quality based on aroma analyses and chemometrics

In this work, soft modeling based on chemometric analyses of coffee beverage sensory data and the chromatographic profiles of volatile roasted coffee compounds is proposed to predict the scores of acidity, bitterness, flavor, cleanliness, body, and overall quality of the coffee beverage. A partial least squares (PLS) regression method was used to construct the models. The ordered predictor selection (OPS) algorithm was applied to select the compounds for the regression model of each sensory attribute in order to take only significant chromatographic peaks into account. The prediction errors of these models, using 4 or 5 latent variables, were equal to 0.28, 0.33, 0.35, 0.33, 0.34 and 0.41, for each of the attributes and compatible with the errors of the mean scores of the experts. Thus, the results proved the feasibility of using a similar methodology in on-line or routine applications to predict the sensory quality of Brazilian Arabica coffee.

Appropriateness of outpatient gastrointestinal endoscopy in a non-academic hospital

AIM: To assess the appropriate use and the diagnostic yield of upper gastrointestinal endoscopy and colonoscopy in this subgroup of patients.

METHODS: In total, 789 consecutive outpatients referred for gastrointestinal (GI) endoscopy [381 for esophagogastroduodenoscopy (EGD) and 408 for colonoscopy] were prospectively enrolled in the study. The American Society for Gastrointestinal Endoscopy (ASGE) guidelines were used to assess the relationship between appropriateness and the presence of relevant endoscopic findings.

RESULTS: The overall inappropriate rate was 13.3%. The indications for EGD and colonoscopy were, respectively, appropriate in 82.7% and 82.6% of the exams, uncertain in 5.8% and 2.4% and inappropriate in 11.5% and 15%. The diagnostic yield was significant higher for EGDs and colonoscopies judged appropriate and uncertain when compared with those considered inappropriate (EGD: 36.6% vs 36.4% vs 11.4%, P = 0.004; Colonoscopy: 24.3% vs 20.0% vs 3.3%, P = 0.001). Of the 25 malignant lesions detected, all but one was detected in exams judged appropriate or uncertain.

CONCLUSION: This study shows a good adherence to ASGE guidelines by the referring physicians and a significant increase of the diagnostic yield in appropriate examinations, namely in detecting neoplastic lesions. It underscores the importance that the appropriateness of the indication assumes in assuring high-quality GI endoscopic procedures.

A comparative study of two methods of colonic cleansing before colonoscopy

BACKGROUND/AIMS

good colonic preparation is essential to perform a complete and safe colonoscopy. The preparation used in the Endoscopy Unit was adopted after testing it against the classic 4-liter polyethylene glicol (PEG) preparation (Klean-Prep). Recently a new 3-liter PEG preparation was commercialised in Portugal, Endo-Falk, which appeared to be simpler and effective. The present study compared the preparation we usually use (a combination of 4 tablets of bisacodyl with 2-liter PEG and enemas) with this new preparation.

METHODOLOGY

we enrolled 305 patients in 2 groups. Group 1 was given our usual preparation, as described above and group 2 was given the new 3-liter preparation, Endo-Falk. All patients were ambulatory, and only patients undergoing total colonoscopies were included. Patients with benign or malignant stenosis and patients who had previously undergone colorectal resection were excluded. Preparation was graded as good when there were no stools and little liquid in the colon, fair when there were stools or liquid that could be aspirated and did not obscure the mucosa and bad when stools or excess liquid prevented an adequate view of the surface or precluded polipectomy.

RESULTS

The present study included 164 male and 141 female patients, with a mean age of 61.3 years (no difference between the demographic data). In group 1 the preparation was good in 57.5%, fair in 28.5% and bad in 14% of patients and in group 2 the preparation was good in 33.1%, fair in 48.9% and bad in 18% (p < 0.001). Colonoscopies were complete in 89.9% of all patients.

CONCLUSIONS

The usual preparation was better than the new 3-liter PEG solution.

Prediction of sensory properties of Brazilian Arabica roasted coffees by headspace solid phase microextraction-gas chromatography and partial least squares

Volatile compounds in fifty-eight Arabica roasted coffee samples from Brazil were analyzed by SPME-GC-FID and SPME-GC-MS, and the results were compared with those from sensory evaluation. The main purpose was to investigate the relationships between the volatile compounds from roasted coffees and certain sensory attributes, including body, flavor, cleanliness and overall quality. Calibration models for each sensory attribute based on chromatographic profiles were developed by using partial least squares (PLS) regression. Discrimination of samples with different overall qualities was done by using partial least squares-discriminant analysis (PLS-DA). The alignment of chromatograms was performed by the correlation optimized warping (COW) algorithm. Selection of peaks for each regression model was performed by applying the ordered predictors selection (OPS) algorithm in order to take into account only significant compounds. The results provided by the calibration models are promising and demonstrate the feasibility of using this methodology in on-line or routine applications to predict the sensory quality of unknown Brazilian Arabica coffee samples. According to the PLS-DA on chromatographic profiles of different quality samples, compounds 3-methypropanal, 2-methylfuran, furfural, furfuryl formate, 5-methyl-2-furancarboxyaldehyde, 4-ethylguaiacol, 3-methylthiophene, 2-furanmethanol acetate, 2-ethyl-3,6-dimethylpyrazine, 1-(2-furanyl)-2-butanone and three others not identified compounds can be considered as possible markers for the coffee beverage overall quality.

Acute necrotizing esophagitis: a large retrospective case series

BACKGROUND AND STUDY AIMS

Acute necrotizing esophagitis is a rarely described entity. Its incidence has not yet been established, and its multifactorial etiology remains unknown. The aim of the present study was to establish the incidence, clinical presentation, endoscopic course, accompanying factors, and pathogenesis of the condition.

PATIENTS AND METHODS

A retrospective analysis of clinical, laboratory, endoscopic and histological data and the clinical course in 29 patients with acute necrotizing esophagitis was carried out over a 5-year period.

RESULTS

Acute necrotizing esophagitis was observed in 29 of 10 295 upper gastrointestinal endoscopies (0.28 %) carried out during the 5-year period. The average age of the patients was 75.24 years (range 40 - 91), and they were predominantly male. Eighty-three percent of the patients had comorbid conditions. In all cases, acute necrotizing esophagitis became evident with upper gastrointestinal bleeding, without hemodynamic stabilization in the majority of cases (75.9 %). The lesions predominantly affected the lower two-thirds of the esophagus (59 %), and there were coexisting abnormal endoscopic findings in 83 % of cases. Empirical supportive therapy, including oral nutritional rest, omeprazole, sucralfate (15 cases) and broad-spectrum antibiotics (7 cases) was provided. The condition resolved in all patients. Ten patients in the group died of other causes (coexisting illnesses).

CONCLUSIONS

Acute necrotizing esophagitis was more commonly recognized than has previously been reported. It is a serious clinical entity that should be considered in the differential diagnosis of upper gastrointestinal bleeding, particularly in elderly patients. The prognosis depends more on the patient's advanced age and on comorbid illnesses than on the course of the esophageal lesions, which resolved in all patients in this series.

Leiomyosarcoma of the inferior vena cava--a very rare case report

The authors present a case report of a patient with abdominal pain that began 6 months before hospital admission. Ambulatory abdominal echography and computed tomography (CT) revealed partial thrombosis of the inferior vena cava (IVC) with right atrial extension. During hospitalization, magnetic resonance imaging (MRI) revealed aspects suggesting a tumoral lesion of the right atrium, rather than a thrombus, with tumoral extension to the IVC. The echocardiogram showed images suggesting a right atrial tumor. Transesophageal echocardiography confirmed the diagnosis. During surgery, an IVC tumor was found invading the right atrium, which histopathology confirmed as a leiomyosarcoma. The authors present this case because this type of tumor is rare (21 cases worldwide at this anatomic site), it is difficult to diagnose, and its management has not been adequately described. The authors review the literature relevant to this case.

Monitoring biogenic volatile compounds emitted by Eucalyptus citriodora using SPME

A procedure to monitor BVOC emitted by living plants using SPME technique is presented. For this purpose, a glass sampling chamber was designed. This device was employed for the characterization of biogenic volatile compounds emitted by leaves of Eucalyptus citriodora. After extraction with SPME fibers coated with PDMS/ DVB, it was possible to identify or detect 33 compounds emitted by this plant. A semiquantitative approach was applied to monitor the behavior of the emitted BVOC during 9 days. Circadian profiles of the variation in the concentration of isoprene were plotted. Using diffusion-based SPME quantitation, a recently introduced analytical approach, with extraction times as short as 15 s, it was possible to quantify subparts-per-billion amounts of isoprene emitted by this plant.

Design and validation of portable SPME devices for rapid field air sampling and diffusion-based calibration

The use of SPME fibers coated with porous polymer solid phases for quantitative purposes is limited due to effects such as interanalyte displacement and competitive adsorption. For air analysis, these problems can be averted by employing short exposure times to air samples flowing around the fiber. In these conditions, a simple mathematical model allows quantification without the need of calibration curves. This work describes two portable dynamic air sampling (PDAS) devices designed for application of this approach to nonequilibrium SPME sampling and determination of airborne volatile organic compounds (VOCs). The use of a PDAS device resulted in greater adsorbed VOC mass compared to the conventional SPME extraction in static air for qualitative screening of live plant aromas and contaminants in indoor air. For all studied air samples, an increase in the number of detected compounds and sensitivity was also observed. Quantification of aromatic VOCs in indoor air was also carried out using this approach and the PDAS/SPME device. Measured VOC concentrations were in low parts-per-billion by volume range using only 30-s SPME fiber exposure and were comparable to those obtained with a standard NIOSH method 1501. The use of PDAS/SPME devices reduced the total air sampling and analysis time by several orders of magnitude compared to the NIOSH 1501 method.

Diffusion-based calibration for SPME analysis of aqueous samples

When an SPME fiber is exposed for a short period of time to a flowing fluid sample, the amount of extracted analyte depends on its diffusion coefficient in the matrix medium, and it can be correlated to its concentration using a simple mathematical model. This work discusses the extension of this approach, already validated for gaseous samples and SPME fibers coated with strong adsorbent coatings, to the diffusion-based quantification of analytes present in aqueous samples. Dilute aqueous solutions of aromatic hydrocarbons were used as model samples and vials were modified to use conventional magnetic agitation with controlled tangential flow of the test solution around the fiber. It was demonstrated that, with proper selection of the stirring speed and sampling time, the same diffusion-based quantitative model used for gas samples could be employed. Under optimal conditions, the concentrations of the evaluated aromatic hydrocarbons were estimated with relative standard deviations between 0.8 and 3.6% and without deviation from the expected values within this precision range. Considering the extraction times involved, between 30 and 60 s, the approach here presented is the fastest possible technique for direct extraction of analytes from liquid samples.

Screening of Brazilian fruit aromas using solid-phase microextraction-gas chromatography-mass spectrometry

Manual headspace solid-phase microextraction (SPME) coupled to gas chromatography-mass spectrometry (GC-MS) was used for the qualitative analysis of the aromas of four native Brazilian fruits: cupuassu (Theobroma grandiflorum, Spreng.), cajá (Spondias lutea. L.), siriguela (Spondias purpurea, L.) and graviola (Anona reticulata, L). Industrialized pulps of these fruits were used as samples, and extractions with SPME fibers coated with polydimethylsiloxane, polyacrylate, Carbowax and Carboxen were carried out. The analytes identified included several alcohols, esters, carbonyl compounds and terpernoids. The highest amounts extracted, evaluated from the sum of peak areas, were achieved using the Carboxen fiber.

[Somatostatin and SMS 201-995 (octreotide): clinical and therapeutic aspects]

Nowadays, the digestive system, must be considered as an actual endocrinous gland. The authors, after pointing out the pharmacological and immunomodulating actions of endogenous somatostatine, briefly describe a new synthetic octapeptid, somatostatine-analogue, with similar pharmacological effects (octreotide). Finally they stress the therapeutic trials in which the adverse effects, dosage and administration have been studied.

Assessing psychodynamic conflicts: I. Reliability of the idiographic conflict formulation method

Recent years have seen increasing interest in devising methods of studying psychodynamic phenomena. These efforts have had confront difficulties, first, in specifying the data, the observation language, and rules of inference for psychodynamic propositions, and second, in determining the reliability and validity of the measures used. Given how "fuzzy" traditional psychodynamic concepts are, it is no wonder that psychodynamic clinicians from Freud onward have achieved more success in generating new hypotheses than in testing their validity. As Reichenbach (1938) has observed, science requires that discovery be followed by systematic validation of all new propositions, regardless of their degree of popular acceptance. At the core of efforts to study psychodynamics have been methods to study ego functioning (Bellak and Goldsmith 1984), defense mechanisms (Perry and Copper 1988), and psychodynamic conflicts. This paper reports on the reliability of the Idiographic Conflict Formulation (ICF), a guided method for formulating an individual's psychodynamic conflicts.