Baiona's Consensus Statement for Fecal Incontinence. Spanish Association of Coloproctology

Faecal incontinence (FI) is a major health problem, both for individuals and for health systems. It is obvious that, for all these reasons, there is widespread concern for healing it or, at least, reducing as far as possible its numerous undesirable effects, in addition to the high costs it entails. There are different criteria for the diagnostic tests to be carried out and the same applies to the most appropriate treatment, among the numerous options that have proliferated in recent years, not always based on rigorous scientific evidence. For this reason, the Spanish Association of Coloproctology (AECP) proposed to draw up a consensus to serve as a guide for all health professionals interested in the problem, aware, however, that the therapeutic decision must be taken on an individual basis: patient characteristics/experience of the care team. For its development it was adopted the Nominal Group Technique methodology. The Levels of Evidence and Grades of Recommendation were established according to the criteria of the Oxford Centre for Evidence-Based Medicine. In addition, expert recommendations were added briefly to each of the items analysed.

Do bad habits bring a double constipation risk?

BACKGROUND/AIMS

Good dietary habits, fluid intake, and regular exercise are considered to ease defecation although very few cases of chronic constipation can be managed through these approaches alone. Good defecation habits are recommended to avoid chronic constipation; however, the literature regarding this remains scarce. In this paper, we aimed to assess the association of bad habits concerning defecation, such as postponing, reluctance, or avoiding defecation anywhere but at home, with chronic constipation.

MATERIALS AND METHODS

This was a cross-sectional observational study including subjects from a tertiary hospital taskforce. In total, 415 of 910 eligible subjects were randomly selected. A cluster of questionnaires easy to understand and fill out was distributed. The questionnaires included queries regarding demographic data; past medical history; the presence of constipation; and dietary, other lifestyle, and defecation habits. The Rome III criteria for chronic constipation were also recorded.

RESULTS

In total, 24.3% of the subjects considered themselves constipated, and 26.5% fulfilled the Rome III criteria for constipation. There were obvious differences in constipation prevalence by sex (men 5% vs. women 31%). Fiber-rich diet, fluid intake, and exercise habits were not related to constipation. Defecation habits significantly correlated with the presence or absence of constipation: regular schedule (OR 0.39; CI 95% 0.23-0.67), persistently postponing defecation (OR 1.94; CI 95% 1.13-3.34), or avoiding defecation anywhere but at home (OR 2.38; CI 95% 1.4-4.1).

CONCLUSION

Compared with dietary habits, behavioral aspects surrounding defecation are more related to chronic constipation. Our results indicate that the modification of these bad habits may be the first step in chronic constipation treatment.

Prevalence of anal incontinence in a working population within a healthcare environment

OBJECTIVES

Anal incontinence is a devastating affliction with several considerations that make it difficult to define in terms of epidemiology with good precision. The aim of the present work is to study the prevalence of an important disorder such as anal incontinence in a healthy working population within a sanitary environment.

MATERIAL AND METHODS

A cluster of easy understanding and filling inquiry forms are distributed to 910 apparently healthy individuals at our hospital. This questionnaires include filiation data, passed medical history, presence or not of Incontinence and other symptoms such as urgency. The Cleveland Clinic Incontinence Score is also registered.

RESULTS

Anal incontinence is present in a 21.2% of subjects when considered in any of it forms (flatus, liquid or solid faeces). A Clevleand Clinic Incontinence Score higher than 6 was obtained in a 7.3% of the sample and higher than 10 in 1.2%. No gender predominance has been identified. A slightly higher severity is recognised with increasing age. Obstetric and anal surgical background are the only related factors identified in the studied sample.

CONCLUSIONS

Faecal incontinence is a high prevalent affliction, even among apparently healthy population. Considering the aetiologic factors that have been established, prevention during obstetric and anal surgical procedures is absolutely mandatory.

Contribution of intraoperative colonoscopy in a colorectal surgery unit. Scand J Gastroenterol 2017;52:1292-1297. [PMID: 28768440 DOI: 10.1080/00365521.2017.1362465]

OBJECTIVES

Intraoperative colonoscopy (IC) is routinely used in colorectal surgery procedures, both oncologic and benign ones. Despite its extensive use there is a lack of literature addressing this important issue. The aims of this paper are to determine the contributions of this tool, especially considering changes in attitude from preoperative designed intervention.

MATERIALS AND METHODS

This study is a retrospective analysis of a prospective maintained database. Patients who underwent colorectal resection and IC during a four-year period (2009-2012). The indications for performing IC in our unit are: Incomplete preoperative colonoscopy, confirm the exact location of the tumor and polypectomy of any lesion distant from the planned resection segment.

RESULTS

The success rate in performing IC is 100%, including 42% of them made trans-anastomotic. No postoperative complications that were attributable to the endoscopy were detected. Routine practice led to a change in attitude in 5% of the patients analyzed; 2% of the global sample corresponded to synchronous tumors finding. Of those patients in whom polypectomies where achieved during the procedure a 14.3% of potentially malignant lesions were resected.

CONCLUSIONS

Intraoperative colonoscopy is a useful and safe tool that in view of these results should be taken into account at any colorectal surgery unit. Trans-anastomotic techniques do not raise morbidity.

Acquired recto-uretral fistulas: etiopathogenesis, diagnosis and therapeutic options

Rectouretral fistulas are a rare disease, but represent an important problem for the patient that suffers them and a challenge for the urologist and colorectal surgeon who has to manage them. A wide review has been performed focusing on etiopathogenic factors, diagnostic and therapeutic options including the analysis of different surgical techniques. PubMed, MEDLINE y EMBASE medical database were searched up to September 2014.

Vaccination against hepatitis B with 4-double doses increases response rates and antibodies titers in HIV-infected adults

BACKGROUND

Antibody responses to standard regimens of hepatitis B (HBV) vaccination are lower in HIV-infected subjects and the best hepatitis B vaccine schedule in this population is not known.

OBJECTIVE

To assess the immunogenicity and to evaluate predictors of serologic response of a modified regimen of a HBV recombinant vaccine in a cohort of HIV-infected subjects.

METHODS

HIV-infected subjects received 4 doses (40 μg) of a recombinant HBV vaccine at 0, 1, 2 and 6 months. Demographic information as well as CD4 cell count and plasma viral load were assessed at baseline. Protective and strong responses were defined as an anti-HBs titer ≥10 mIU/mL and ≥100 mIU/mL, respectively and were evaluated one month after the third and the fourth doses.

RESULTS

163 HIV-infected individuals were evaluated 67 (40%) were male and median age was 37 years. Median CD4 cell count was 385 cells/mm(3) and 113 (70%) had undetectable HIV-1 viral load. Protective antibody response was observed in 83 and 91% and a strong antibody response was observed in 62 and 80% of the subjects after 3 and 4 doses, respectively. In a multivariate logistic model undetectable HIV-1 viral load and higher CD4 cell counts were independent predictors of a strong antibody response after 4 doses. Patients with undetectable HIV viral load were almost 3 times more likely to have anti-HBs titers above 100 mIU/mL than those with detectable viral load.

CONCLUSIONS

A 4-double-dose regimen of a recombinant HBV vaccine increased response rates and determined higher antibody titers which may translate in prolonged protection against HBV. Inclusion of a fourth dose of HBV vaccine for HIV-infected subjects should be considered in the public health setting.

Expression of inflammatory cytokines and Toll-like receptors in the brain and respiratory tract of pigs infected with porcine reproductive and respiratory syndrome virus

The objective of this experiment was to evaluate the central and peripheral expression of selected pro-inflammatory cytokines and Toll-like receptors (TLRs) in pigs infected with porcine reproductive and respiratory syndrome virus (PRRSV). Twenty-four 8-week-old pigs were inoculated with either sterile medium or PRRSV. Pigs were monitored 14d after inoculation and then euthanized for tissue sample collection. PRRSV was detected in serum, lung and brain tissue of pigs given PRRSV but not in any tissue of pigs given medium. Infection with PRRSV increased serum levels of IL-1beta, IL-6, TNFalpha, and IFNgamma and elicited a mild transient fever and reduced growth performance. Infection by PRRSV also increased mRNA for the pro-inflammatory cytokines as well as mRNA for TLR3, TLR4, and TLR7 in the tracheobronchial lymph nodes. The TLR3, TLR4, TLR7 and most of the pro-inflammatory genes also were up-regulated in discrete brain areas of PRRSV-infected pigs. Collectively, the results indicate that following inoculation, PRRSV is present in the periphery and brain and that infection is associated with a peripheral and central pro-inflammatory response, fever, and reduced growth performance. The findings are interpreted to suggest the innate immune system of the brain is responsive to PRRSV infection.

High rates of serological response to a modified hepatitis B vaccination schedule in HIV-infected adults subjects

We evaluated a modified HBV regimen in a cohort of HIV-infected subjects in Rio de Janeiro, Brazil. HIV-infected subjects with no serologic evidences of previous hepatitis B infection were immunized with 4 doses (40 microg each) of recombinant hepatitis B vaccine given at 0, 1, 2 and 6 months. Blood samples were collected 1 month after the last dose and anti-HBs titers were measured. A protective antibody response was defined as an anti-HBs titer >or=10 mIU/mL. Forty-seven subjects (30 women, 17 men; mean age was 36 years, ranging from 21 to 58 years) were included in the final analysis. Median baseline CD4+ lymphocyte count was 402 cells/mm(3) and 33 subjects (70%) had an HIV viral load below 80 copies/mL. A protective antibody response was observed in 42 (89%) subjects. Thirty-seven (78%) and 28 (60%) patients developed anti-HBs titers higher than 100 mIU/mL and 1000 mIU/mL, respectively. 1 out of 5 non-responders (20%) had an HIV viral load below the detection limit, in contrast with 32 (76%) of those with an adequate serologic response (p=0.02). These findings suggest that 4-double dose alternative schedule may be considered to overcome the lower seroconversion rates observed with the standard regimens in HIV-infected subjects.

Shirley Glasstone Hughes Memorial Prize for Dental Research: an evaluation of the output 15 years after the Trust's inception

In May 2005, a decision was taken by the Shirley Glasstone Hughes (SGH) Foundation trustees to suspend investments in research for one year, to allow a review of the outcomes of SGH research funding over the past 15 years. Money was instead directed to the BDA Research Unit, to employ a staff member who would conduct the evaluation under the supervision of the BDA Scientific Adviser. The evaluation focused on three aspects of the research produced: 1) relevance to primary dental care, 2) scientific quality and impact on the research community, and 3) grant recipients' feelings about SGH funding and whether the mechanisms of supporting research could be improved. The methods used included questioning BDA members about the research they found of interest and relevance, checking research outputs against standardised quality criteria, examining impact factors and citation rates (relative to the funding received) and questioning grant recipients about their experience with SGH funding. The results implied that the fund had largely been spent on research themes felt to be relevant to practice by BDA members. In addition, the publication rate, publication quality, impact and citation indices demonstrated the SGH research work to be largely of high quality. Recipients of the fund indicated several factors which might improve the experience of receiving funding and possibly also improve the research output. It can be concluded that the SGH funds have largely been well spent but that it is worth considering implementing changes which would make the research findings of greater relevance to clinical practice.

Effects of mannan oligosaccharide and an antimicrobial product in nursery diets on performance of pigs reared on three different farms1

The objective of this experiment was to compare the effects of dietary mannan oligosaccharide (MOS) and a feed-grade antimicrobial (AM) on growth performance of nursery pigs reared on three different farms (A and B were large-scale commercial farms, and C was located at Michigan State University). On all farms, production was continuous flow by building, but all-in/all-out by room. Within each nursery facility, all pigs on the experiment were in one room. Pigs (Farm A, n = 771, weaning age = 18.4 d; Farm B, n = 576, weaning age = 19.0 d; Farm C, n = 96, weaning age = 20.6 d) were blocked (within farm) by BW and sex and allotted randomly to dietary treatments arranged in a 2 x 2 factorial. The two factors were 1) with and without MOS (0.3% in Phase I, 0.2% in Phases II, III, and IV; as-fed basis) and 2) with and without AM (110 mg of tylosin and 110 mg of sulfamethazine/kg of diet in all phases; as-fed basis). The four nursery phases were 4, 7, 14, and 17 d, respectively. With 35, 20, and 4 pigs per pen on Farms A, B, and C, respectively, space allowances per pig were 0.29, 0.26, and 0.56 m2. Across all farms, the addition of AM and MOS plus AM increased (P < 0.05) ADG (368, 406, and 410 g/d for control, AM, and MOS plus AM, respectively and increased ADFI (661, 703, and 710 g/d for control, AM, and MOS plus AM, respectively) for the entire 42-d experiment. The addition of MOS also increased ADG (P < 0.05) from d 0 to 42 of the experiment (394 g/d). Performance differed depending on farm (P < 0.01). Antimicrobial did not affect growth performance on Farm B, but it increased (P < 0.05) ADG on Farms A and C, ADFI on Farm A, and G:F on Farm C. Growth improvements with MOS on Farms A and B were not significant; however, pigs on Farm C fed MOS had greater (P < 0.05) ADG, ADFI, and G:F than controls. The results of this study suggest that MOS may be an alternative to tylosin and sulfa-methazine as a growth promotant in nursery diets.

Assessing the cariogenic potential of some infant formulas, milk and sugar solutions

Using a desalivated rat model, the authors found that several commonly used infant formulas had significant cariogenic potential. Sucrose was by far the most cariogenic and cows' milk the least cariogenic of all the products examined. The data show that dental practitioners and other health care professionals should discourage the use of sugar in baby bottles and provide information on which formulas are least likely to induce caries when continuous bottle feeding is unavoidable.

Effects of iron salts in sucrose on dental caries and plaque in rats

Anaemia caused by iron deficiency and dental caries are still among the most prevalent diseases in some developing countries. Anaemia can be prevented by iron fortification of food. Previous studies demonstrated that iron-sucrose, which has been used for prevention of anaemia, reduces the incidence of caries in rats. The aim of the present study was to compare the influence of ferrous sulphate and ferric glycerophosphate co-crystallized with sucrose on the incidence of dental caries in rats. Forty-eight desalivated rats were caged in a programmed feeder and received their essential nutrition by gavage. The animals were fed 17 meals per day at hourly intervals of 88 parts/10(6) Fe++ or Fe co-crystallized with sucrose. Plain sucrose and calcium glycerophosphate with sucrose were used as control groups. Both ferric- and ferrous-sucrose meals reduced the incidence of smooth-surface and sulcal caries in rats. Stain formation, organic acid production and acidogenic activity of dental plaque in animals receiving iron-sucrose meals were also investigated. Ferric glycerophosphate did not induce extrinsic staining on the tooth surface. The concentration of organic acids did not differ significantly among the groups. The acidogenic activity of plaque in animals receiving either of the iron-sucrose meals tended to be lower than that of the control groups. The possibility that iron-sucrose might reduce the prevalence of two major public health problems, dental caries and anaemia, makes this preventive approach extremely attractive for additional investigation.

Influence of iron alone or with fluoride on caries development in desalivated and intact rats

Sugar is used as a vehicle for iron fortification in communities where anemia is prevalent. The purpose of the present study was to investigate the relationship between caries experience and iron concentration in sugar fed to rats subjected to a severe cariogenic challenge. Desalivated and intact animals were assigned to 4 different diet subgroups, 3 receiving iron sucrose (350, 175 and 88 ppm Fe) and a control group. The influence of iron sugar combined with 10 ppm F in drinking water was explored in an additional study. Iron reduces the incidence of smooth-surface carries in desalivated rats at concentrations as low as 88 ppm Fe. In addition, a combination of iron and fluoride reduced the incidence of dental caries in our rats.

Effects of frequency of exposure to iron-sucrose on the incidence of dental caries in desalivated rats

World Health Organization (WHO) estimates that 2.5 billion people have anemia caused by iron deficiency that could be prevented by fortification of food; sugar, for example, has been used successfully as a vehicle for dietary iron fortification. The inclusion of 88 ppm of iron (as FeSO4) co-crystallized with sugar has been shown to reduce the incidence of caries by more than 30% when rats are fed 17 meals daily at hourly intervals. The purpose of the present study was to determine the influence of varying the number of daily exposures to iron on caries in desalivated rats. Four litters of 12 Sprague-Dawley rats were desalivated when aged 25 days and caged in a programmed feeder. All animals received their essential nutrition by gavage and 17 meals of sucrose daily. In Group A, 6 meals contained 88 ppm Fe; in Group B, 3 meals continued iron: Group C had 2 meals, and in Group D, no iron was added. The investigation continued for 3 weeks. Smooth-surface and sulcal (in parentheses) caries scores were: Group A 60.8 (39.4); Group B 72.4 (41.3); Group C 73.1 (41.3), and Group D 92.9 (49.2). Caries scores in all the iron groups were statistically lower than in the control group. Severity scores followed a similar pattern. Thus, as few as 2 daily exposures to iron-sucrose had a significant effect on caries development; therefore the use of iron as a cariostatic agent is worthy of further exploration. The concept that two major public health problems could be alleviated by the addition of iron to sucrose is indeed attractive.