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Colombo G, Aloisio E, Panteghini M. Laboratory investigation of peritoneal fluids: an updated practical approach based on the available evidence. J Clin Pathol 2024:jcp-2023-209282. [PMID: 38538073 DOI: 10.1136/jcp-2023-209282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/10/2024] [Indexed: 04/11/2024]
Abstract
Even though analysis of peritoneal fluids (PF) is often requested to medical laboratories for biochemical and morphological tests, there is still no mutual agreement on what the most appropriate way is to manage PF samples and which tests should be appropriately executed. In this update, we tried to identify the most useful tests for PF analysis to establish best practice indications. We performed a literature review and examined available guidelines to select the most appropriate tests by an evidence-based approach. Accordingly, the basic PF profile should include (1) serum to effusion albumin gradient and (2) automated cell counts with differential analysis. This profile allows to determine the PF nature, differentiating between 'high-albumin gradient' and 'low-albumin gradient' effusions, which helps to identify the pathophysiological process causing the ascites formation. Restricted to specific clinical situations, additional tests can be requested as follows: PF lactate dehydrogenase (LDH) and glucose, to exclude (LDH) or confirm (glucose) secondary bacterial peritonitis; PF total protein, to differentiate ascites of cardiac origin from other causes; PF (pancreatic) amylase, for the identification of pancreatic ascites; PF bilirubin, when a choleperitoneum is suspected; PF triglycerides, in differentiating chylous from pseudochylous ascites and PF creatinine, to detect intraperitoneal urinary leakage.
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Affiliation(s)
- Giulia Colombo
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milano, Italy
| | - Elena Aloisio
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milano, Italy
| | - Mauro Panteghini
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milano, Italy
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2
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Shepherd NA. Macroscopic pathology and all that: a personal view. J Clin Pathol 2024; 77:157-163. [PMID: 38123351 DOI: 10.1136/jcp-2023-209106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 11/26/2023] [Indexed: 12/23/2023]
Abstract
I hope that this treatise adds to the excellent reviews by Varma and colleagues, emphasising the importance of accurate macroscopic assessment and report provision. I have especially highlighted the importance of not divorcing the clinical data and the macroscopic analysis from the microscopic assessment as all are required to provide an accurate and cogent overall composition. The review has also identified areas where the evolution of pathological practice has gone a little awry and requires to be modified and/or justified with evidence base. There is also an emphasis on block economy, as there is no doubt that considerable savings can be made if more attention is paid to more judicious block selection. It is also commended that subspecialties other than gastrointestinal pathology introduce reporting quality standards, like lymph node harvest numbers and other important prognostic and management indicators, to improve the quality of macroscopic pathology worldwide to the benefit of our service users and their patients.
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Affiliation(s)
- Neil A Shepherd
- Gloucestershire Cellular Pathology Laboratory, Cheltenham, Gloucestershire, UK
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3
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Zhang Z, Du L, Ji Q, Liu H, Ren Z, Ji G, Bian ZX, Zhao L. The Landscape of Gut Microbiota and Its Metabolites: A Key to Understanding the Pathophysiology of Pattern in Chinese Medicine. Am J Chin Med 2024; 52:89-122. [PMID: 38351704 DOI: 10.1142/s0192415x24500046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Liver Stagnation and Spleen Deficiency (LSSD) is a Chinese Medicine (CM) pattern commonly observed in gastrointestinal (GI) diseases, yet its biological nature remains unknown. This limits the global use of CM medications for treating GI diseases. Recent studies emphasize the role of gut microbiota and their metabolites in the pathogenesis and treatment of LSSD-associated GI diseases. There is increasing evidence supporting that an altered gut microbiome in LSSD patients or animals contributes to GI and extra-intestinal symptoms and affects the effectiveness of CM therapies. The gut microbiota is considered to be an essential component of the biological basis of LSSD. This study aims to provide an overview of existing research findings and gaps for the pathophysiological study of LSSD from the gut microbiota perspective in order to understand the relationship between the CM pattern and disease progression and to optimize CM-based diagnosis, prevention, and therapy.
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Affiliation(s)
- Zhaozhou Zhang
- School of Integrative Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, P. R. China
| | - Liqing Du
- School of Integrative Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, P. R. China
| | - Qiuchen Ji
- School of Integrative Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, P. R. China
| | - Hao Liu
- School of Integrative Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, P. R. China
| | - Zhenxing Ren
- Center for Translational Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, P. R. China
| | - Guang Ji
- Institute of Digestive Diseases, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, P. R. China
| | - Zhao-Xiang Bian
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong SAR, P. R. China
| | - Ling Zhao
- School of Integrative Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, P. R. China
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4
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Gupta NY, Al Diffalha S, Russ KB. An Unusual Case of Colitis in a Bone Marrow Transplant Patient. Gastroenterology 2024:S0016-5085(24)00060-X. [PMID: 38253187 DOI: 10.1053/j.gastro.2024.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 01/24/2024]
Affiliation(s)
- Nikita Y Gupta
- Department of Medicine, State University of New York Upstate Medical University, Syracuse, New York
| | - Sameer Al Diffalha
- Department of Pathology, University of Alabama at Birmingham Hospital, Birmingham, Alabama
| | - Kirk B Russ
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Alabama at Birmingham Hospital, Birmingham, Alabama.
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Shah SC, Halvorson AE, Lee D, Bustamante R, McBay B, Gupta R, Denton J, Dorn C, Wilson O, Peek R, Gupta S, Liu L, Hung A, Greevy R, Roumie CL. Helicobacter pylori Burden in the United States According to Individual Demographics and Geography: A Nationwide Analysis of the Veterans Healthcare System. Clin Gastroenterol Hepatol 2024; 22:42-50.e26. [PMID: 37245717 DOI: 10.1016/j.cgh.2023.05.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 04/22/2023] [Accepted: 05/13/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND & AIMS There are no contemporary large-scale studies evaluating the burden of Helicobacter pylori in the United States according to detailed demographics. The primary objective was to evaluate H pylori positivity in a large national healthcare system according to individual demographics and geography. METHODS We conducted a nationwide retrospective analysis of adults in the Veterans Health Administration who completed H pylori testing between 1999 and 2018. The primary outcome was H pylori positivity overall, as well as according to zip code-level geography, race, ethnicity, age, sex, and time period. RESULTS Among 913,328 individuals (mean, 58.1 years; 90.2% male) included between 1999 and 2018, H pylori was diagnosed in 25.8%. Positivity was highest in non-Hispanic black (median, 40.2%; 95% confidence interval [CI], 40.0%-40.5%) and Hispanic (36.7%; 95% CI, 36.4%-37.1%) individuals and lowest in non-Hispanic white individuals (20.1%; 95% CI, 20.0%-20.2%). Although H pylori positivity declined in all racial and ethnic groups over the timeframe, the disproportionate burden of H pylori in non-Hispanic black and Hispanic compared with non-Hispanic white individuals persisted. Approximately 4.7% of the variation in H pylori positivity was explained by demographics, with race and ethnicity accounting for the vast majority. CONCLUSIONS The burden of H pylori is substantial in the United States among veterans. These data should (1) motivate research aimed at better understanding why marked demographic differences in H pylori burden persist so that mitigating interventions may be implemented and (2) guide resource allocation to optimize H pylori testing and eradication in high-risk groups.
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Affiliation(s)
- Shailja C Shah
- Gastroenterology Section, Jennifer Moreno Department of Veterans Affairs Medical Center, San Diego, California; Division of Gastroenterology, University of California, San Diego, La Jolla, California.
| | - Alese E Halvorson
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David Lee
- Division of Gastroenterology, University of Maryland Medical Center, Baltimore, Maryland
| | - Ranier Bustamante
- Department of Biostatistics, University of California, San Diego, La Jolla, California
| | - Brandon McBay
- Department of Public Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Rohan Gupta
- College of Medicine, State University of New York Upstate Medical University, Syracuse, New York
| | - Jason Denton
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Chad Dorn
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Otis Wilson
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee; Clinical Services Research and Development, VA Tennessee Valley Healthcare System, Nashville, Tennessee
| | - Richard Peek
- Division of Gastroenterology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Samir Gupta
- Gastroenterology Section, Jennifer Moreno Department of Veterans Affairs Medical Center, San Diego, California; Division of Gastroenterology, University of California, San Diego, La Jolla, California
| | - Lin Liu
- Department of Biostatistics, University of California, San Diego, La Jolla, California
| | - Adriana Hung
- Clinical Services Research and Development, VA Tennessee Valley Healthcare System, Nashville, Tennessee; Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Robert Greevy
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee; Clinical Services Research and Development, VA Tennessee Valley Healthcare System, Nashville, Tennessee
| | - Christianne L Roumie
- Clinical Services Research and Development, VA Tennessee Valley Healthcare System, Nashville, Tennessee; Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; VA Geriatrics Research Education and Clinical Center (GRECC), VA Tennessee Valley Health System, Nashville, Tennessee
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6
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Duci M, Santoro L, Dei Tos AP, Loss G, Mescoli C, Gamba P, Fascetti Leon F. Postoperative Hirschsprung's associated enterocolitis (HAEC): transition zone as putative histopathological predictive factor. J Clin Pathol 2023:jcp-2023-209129. [PMID: 38053256 DOI: 10.1136/jcp-2023-209129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/09/2023] [Indexed: 12/07/2023]
Abstract
AIMS Hirschsprung's-associated enterocolitis (HAEC) is the most severe complication of Hirschsprung disease (HD), and its pathogenesis is still unknown. Length of transition zone (TZ) interposed between aganglionic and normal bowel has been poorly explored as predictor for postoperative HAEC (post-HAEC). This study aimed to identify potential predictive factors for post-HAEC, with a particular focus on histopathological findings. METHODS Data from Hirschsprung patients treated in a single Italian centre between 2010 and 2022 with a follow-up >6 months were collected. Thorough histopathological examination of the resected bowel was conducted, focusing on length of TZ and aganglionic bowel.The degree of inflammatory changes in ganglionic resected bowel was further obtained. Ultra-long HD, total colonic aganglionosis and ultra-short HD were excluded. Bivariate and multivariate regression analysis were performed. RESULTS Thirty-one patients were included; 5 experienced preoperative HAEC (pre-HAEC) and later post-HAEC (16.1%), further 10 patients developed post-HAEC (total post-HAEC 48.38%). Pre-HAEC-history and a TZ<2.25 cm correlated with an early development of post-HAEC. Multivariate analysis identified a TZ<2.25 cm as an independent post-HAEC predictive factor (p=0.0096). Inflammation within the ganglionic zone and a TZ<2.25 cm correlated with higher risk of post-HAEC (p=0.0074, 0.001, respectively). Severe post-HAEC more frequently occurred in patients with pre-HAEC (p=0.011), histological inflammation (p=0.0009) and short TZ (p=0.0015). CONCLUSIONS This study suggests that TZ<2.25 cm predicts the risk of post-HAEC. Preoperative clinical and histopathology inflammation may predispose to worst post-HAEC. Readily available histopathological findings might help identifying patients at higher risk for HAEC and implementing prevention strategies.
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Affiliation(s)
- Miriam Duci
- Pediatric Surgery Unit, Department of Women's and Children's Health, Università degli Studi di Padova, Padova, Italy
| | - Luisa Santoro
- Surgical Pathology and Cytopathology Unit, Department of Medicine - DIMED, University of Padova School of Medicine, Padova, Italy
| | - Angelo Paolo Dei Tos
- Surgical Pathology and Cytopathology Unit, Department of Medicine - DIMED, University of Padova School of Medicine, Padova, Italy
| | - Greta Loss
- Pediatric Surgery Unit, Department of Women's and Children's Health, Università degli Studi di Padova, Padova, Italy
| | - Claudia Mescoli
- Surgical Pathology and Cytopathology Unit, Department of Medicine - DIMED, University of Padova School of Medicine, Padova, Italy
| | - Piergiorgio Gamba
- Pediatric Surgery Unit, Department of Women's and Children's Health, Università degli Studi di Padova, Padova, Italy
| | - Francesco Fascetti Leon
- Pediatric Surgery Unit, Department of Women's and Children's Health, Università degli Studi di Padova, Padova, Italy
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7
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Schwenk V, Leal Silva RM, Scharf F, Knaust K, Wendlandt M, Häusser T, Pickl JMA, Steinke-Lange V, Laner A, Morak M, Holinski-Feder E, Wolf DA. Transcript capture and ultradeep long-read RNA sequencing (CAPLRseq) to diagnose HNPCC/Lynch syndrome. J Med Genet 2023; 60:747-759. [PMID: 36593122 PMCID: PMC10423559 DOI: 10.1136/jmg-2022-108931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 12/10/2022] [Indexed: 01/03/2023]
Abstract
PURPOSE Whereas most human genes encode multiple mRNA isoforms with distinct function, clinical workflows for assessing this heterogeneity are not readily available. This is a substantial shortcoming, considering that up to 25% of disease-causing gene variants are suspected of disrupting mRNA splicing or mRNA abundance. Long-read sequencing can readily portray mRNA isoform diversity, but its sensitivity is relatively low due to insufficient transcriptome penetration. METHODS We developed and applied capture-based target enrichment from patient RNA samples combined with Oxford Nanopore long-read sequencing for the analysis of 123 hereditary cancer transcripts (capture and ultradeep long-read RNA sequencing (CAPLRseq)). RESULTS Validating CAPLRseq, we confirmed 17 cases of hereditary non-polyposis colorectal cancer/Lynch syndrome based on the demonstration of splicing defects and loss of allele expression of mismatch repair genes MLH1, PMS2, MSH2 and MSH6. Using CAPLRseq, we reclassified two variants of uncertain significance in MSH6 and PMS2 as either likely pathogenic or benign. CONCLUSION Our data show that CAPLRseq is an automatable and adaptable workflow for effective transcriptome-based identification of disease variants in a clinical diagnostic setting.
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Affiliation(s)
| | | | | | | | | | - Tanja Häusser
- Medizinisch Genetisches Zentrum (MGZ), Munich, Germany
| | - Julia M A Pickl
- Medizinisch Genetisches Zentrum (MGZ), Munich, Germany
- Klinikum der Universität München, Munich, Germany
| | | | - Andreas Laner
- Medizinisch Genetisches Zentrum (MGZ), Munich, Germany
| | - Monika Morak
- Medizinisch Genetisches Zentrum (MGZ), Munich, Germany
- Klinikum der Universität München, Munich, Germany
| | - Elke Holinski-Feder
- Medizinisch Genetisches Zentrum (MGZ), Munich, Germany
- Medizinische Klinik und Poliklinik IV, Campus Innenstadt, Klinikum der Universität München, Munich, Germany
| | - Dieter A Wolf
- Medizinisch Genetisches Zentrum (MGZ), Munich, Germany
- Department of Medicine II, Technical University Munich, Munich, Germany
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Maccioni F, Busato L, Valenti A, Cardaccio S, Longhi A, Catalano C. Magnetic Resonance Imaging of the Gastrointestinal Tract: Current Role, Recent Advancements and Future Prospectives. Diagnostics (Basel) 2023; 13:2410. [PMID: 37510154 PMCID: PMC10378103 DOI: 10.3390/diagnostics13142410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
This review focuses on the role of magnetic resonance imaging (MRI) in the evaluation of the gastrointestinal tract (GI MRI), analyzing the major technical advances achieved in this field, such as diffusion-weighted imaging, molecular imaging, motility studies, and artificial intelligence. Today, MRI performed with the more advanced imaging techniques allows accurate assessment of many bowel diseases, particularly inflammatory bowel disease and rectal cancer; in most of these diseases, MRI is invaluable for diagnosis, staging, and disease monitoring under treatment. Several MRI parameters are currently considered activity biomarkers for inflammation and neoplastic disease. Furthermore, in younger patients with acute or chronic GI disease, MRI can be safely used for short-term follow-up studies in many critical clinical situations because it is radiation-free. MRI assessment of functional gastro-esophageal and small bowel disorders is still in its infancy but very promising, while it is well established and widely used for dynamic assessment of anorectal and pelvic floor dysfunction; MRI motility biomarkers have also been described. There are still some limitations to GI MRI related to high cost and limited accessibility. However, technical advances are expected, such as faster sequences, more specific intestinal contrast agents, AI analysis of MRI data, and possibly increased accessibility to GI MRI studies. Clinical interest in the evaluation of bowel disease using MRI is already very high, but is expected to increase significantly in the coming years.
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Affiliation(s)
- Francesca Maccioni
- Department of Radiological Sciences, Pathology and Oncology, Policlinico Umberto I Hospital, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Ludovica Busato
- Department of Radiological Sciences, Pathology and Oncology, Policlinico Umberto I Hospital, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Alessandra Valenti
- Department of Radiological Sciences, Pathology and Oncology, Policlinico Umberto I Hospital, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Sara Cardaccio
- Department of Radiological Sciences, Pathology and Oncology, Policlinico Umberto I Hospital, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Alessandro Longhi
- Department of Radiological Sciences, Pathology and Oncology, Policlinico Umberto I Hospital, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Carlo Catalano
- Department of Radiological Sciences, Pathology and Oncology, Policlinico Umberto I Hospital, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
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9
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Wren G, Baker E, Underwood J, Humby T, Thompson A, Kirov G, Escott-Price V, Davies W. Characterising heart rhythm abnormalities associated with Xp22.31 deletion. J Med Genet 2023; 60:636-643. [PMID: 36379544 PMCID: PMC10359567 DOI: 10.1136/jmg-2022-108862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/29/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Genetic deletions at Xp22.31 are associated with the skin condition X linked ichthyosis (XLI), and with a substantially increased risk of atrial fibrillation/flutter (AF), in males. AF is associated with elevated thrombosis, heart failure, stroke and dementia risk. METHODS Through: (a) examining deletion carriers with a diagnosis of AF in UK Biobank, (b) undertaking an online survey regarding abnormal heart rhythms (AHRs) in men/boys with XLI and female carriers of XLI-associated deletions and (c) screening for association between common genetic variants within Xp22.31 and idiopathic AF-related conditions in UK Biobank, we have investigated how AHRs manifest in deletion carriers, and have identified associated risk factors/comorbidities and candidate gene(s). Finally, we examined attitudes towards heart screening in deletion carriers. RESULTS We show that AHRs may affect up to 35% of deletion carriers (compared with <20% of age-matched non-carriers), show no consistent pattern of onset but may be precipitated by stress, and typically resolve quickly and respond well to intervention. Gastrointestinal (GI) conditions and asthma/anaemia were the most strongly associated comorbidities in male and female deletion carriers with AHR, respectively. Genetic analysis indicated significant enrichment of common AF risk variants around STS (7 065 298-7 272 682 bp in GRCh37/hg19 genome build) in males, and of common GI disorder and asthma/anaemia risk variants around PNPLA4 (7 866 804-7 895 780 bp) in males and females, respectively. Deletion carriers were overwhelmingly in favour of cardiac screening implementation. CONCLUSION Our data suggest AHRs are frequently associated with Xp22.31 deletion, and highlight subgroups of deletion carriers that may be prioritised for screening. Examining cardiac function further in deletion carriers, and in model systems lacking steroid sulfatase, may clarify AF pathophysiology.
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Affiliation(s)
- Georgina Wren
- School of Psychology, Cardiff University, Cardiff, UK
| | - Emily Baker
- Dementia Research Institute, Cardiff University, Cardiff, UK
- MRC Centre for Neuropsychiatric Genetics and Genomics and Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Jack Underwood
- MRC Centre for Neuropsychiatric Genetics and Genomics and Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
- Neuroscience and Mental Health Innovation Institute, Cardiff University, Cardiff, UK
| | - Trevor Humby
- School of Psychology, Cardiff University, Cardiff, UK
- MRC Centre for Neuropsychiatric Genetics and Genomics and Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
- Neuroscience and Mental Health Innovation Institute, Cardiff University, Cardiff, UK
| | - Andrew Thompson
- School of Psychology, Cardiff University, Cardiff, UK
- Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff, UK
| | - George Kirov
- MRC Centre for Neuropsychiatric Genetics and Genomics and Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Valentina Escott-Price
- MRC Centre for Neuropsychiatric Genetics and Genomics and Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - William Davies
- School of Psychology, Cardiff University, Cardiff, UK
- MRC Centre for Neuropsychiatric Genetics and Genomics and Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
- Neuroscience and Mental Health Innovation Institute, Cardiff University, Cardiff, UK
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Luo X, Maciaszek JL, Thompson BA, Leong HS, Dixon K, Sousa S, Anderson M, Roberts ME, Lee K, Spurdle AB, Mensenkamp AR, Brannan T, Pardo C, Zhang L, Pesaran T, Wei S, Fasaye GA, Kesserwan C, Shirts BH, Davis JL, Oliveira C, Plon SE, Schrader KA, Karam R. Optimising clinical care through CDH1-specific germline variant curation: improvement of clinical assertions and updated curation guidelines. J Med Genet 2022; 60:568-575. [PMID: 36600593 DOI: 10.1136/jmg-2022-108807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 10/10/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Germline pathogenic variants in CDH1 are associated with increased risk of diffuse gastric cancer and lobular breast cancer. Risk reduction strategies include consideration of prophylactic surgery, thereby making accurate interpretation of germline CDH1 variants critical for physicians deciding on these procedures. The Clinical Genome Resource (ClinGen) CDH1 Variant Curation Expert Panel (VCEP) developed specifications for CDH1 variant curation with a goal to resolve variants of uncertain significance (VUS) and with ClinVar conflicting interpretations and continues to update these specifications. METHODS CDH1 variant classification specifications were modified based on updated genetic testing clinical criteria, new recommendations from ClinGen and expert knowledge from ongoing CDH1 variant curations. The CDH1 VCEP reviewed 273 variants using updated CDH1 specifications and incorporated published and unpublished data provided by diagnostic laboratories. RESULTS Updated CDH1-specific interpretation guidelines include 11 major modifications since the initial specifications from 2018. Using the refined guidelines, 97% (36 of 37) of variants with ClinVar conflicting interpretations were resolved to benign, likely benign, likely pathogenic or pathogenic, and 35% (15 of 43) of VUS were resolved to benign or likely benign. Overall, 88% (239 of 273) of curated variants had non-VUS classifications. To date, variants classified as pathogenic are either nonsense, frameshift, splicing, or affecting the translation initiation codon, and the only missense variants classified as pathogenic or likely pathogenic have been shown to affect splicing. CONCLUSIONS The development and evolution of CDH1-specific criteria by the expert panel resulted in decreased uncertain and conflicting interpretations of variants in this clinically actionable gene, which can ultimately lead to more effective clinical management recommendations.
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Affiliation(s)
- Xi Luo
- Department of Pediatrics/Hematology-Oncology, Baylor College of Medicine, Houston, Texas, USA
| | - Jamie L Maciaszek
- Department of Pathology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Bryony A Thompson
- Department of Pathology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Huei San Leong
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Katherine Dixon
- Department of Medical Genetics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Sónia Sousa
- Instituto de Investigação e Inovação em Saúde - (i3S), University of Porto, Porto, Portugal.,Institute of Molecular Pathology and Immunology - (IPATIMUP), University of Porto, Porto, Portugal
| | | | | | - Kristy Lee
- Department of Genetics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Amanda B Spurdle
- Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Arjen R Mensenkamp
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | - Liying Zhang
- Department of Pathology and Laboratory Medicine, University of California Los Angeles, Los Angeles, California, USA
| | | | - Sainan Wei
- Department of Pathology and Laboratory Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Grace-Ann Fasaye
- Genetics Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Brian H Shirts
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Jeremy L Davis
- Surgical Oncology Program, National Cancer Institute, Bethesda, Maryland, USA
| | - Carla Oliveira
- Instituto de Investigação e Inovação em Saúde - (i3S), University of Porto, Porto, Portugal.,Institute of Molecular Pathology and Immunology - (IPATIMUP), University of Porto, Porto, Portugal.,Department of Pathology, University of Porto, Porto, Portugal
| | - Sharon E Plon
- Department of Pediatrics/Hematology-Oncology, Baylor College of Medicine, Houston, Texas, USA
| | - Kasmintan A Schrader
- Department of Medical Genetics, The University of British Columbia, Vancouver, British Columbia, Canada.,Hereditary Cancer Program, BC Cancer, Vancouver, British Columbia, Canada
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Awad H, Sfaira A, Abu Osba Y, Shahin M, Al-Asa'd Y, Isbeih N, Hayagneh W, Shomaf M. Mast Cell Numbers in Primary Eosinophilic Colitis are Significantly Higher than in Secondary Tissue Eosinophilia and Normal Control: a Possible Link to Pathogenesis. Iran J Immunol 2021; 18:220-229. [PMID: 34596587 DOI: 10.22034/iji.2021.88577.1881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Primary Eosinophilic Colitis (PEC) is one of the rare eosinophilic gastrointestinal diseases with a poorly understood pathogenesis. Eosinophilic esophagitis (EE) is the most common and best-understood disease in this category. Activated mast cells (MCs) have a role to play in the tissue damage in EE. It is not known if PEC shares this mechanism. OBJECTIVE This cross-sectional study aimed to investigate the number of MCs in PEC and to compare them with cases of secondary colonic tissue eosinophilia (TE) and normal colon. METHODS The study included 19 PEC cases, 47 cases of secondary tissue eosinophilia and 50 normal colon tissues. Histopathological slides of all cases were reviewed to confirm the diagnosis and count the number of eosinophils. Glass slides for all cases were stained for C-kit (CD117) to highlight and count the MCs. RESULTS The mean number of the MCs in normal controls was 9.7 MCs per HPF (SD= 4.6). The mean number of MCs in the PEC cases was 26.5 (SD=7.1) which was significantly higher than the normal counts (p-value <0.000). The mean number of MCs in the secondary TE group was 18.0 (SD=7.1), which was significantly higher than normal controls; p-value <0.000. Comparing MC counts in PEC and secondary TE also revealed a significant difference with a p-value of < 0.000. CONCLUSION MCs in PEC are significantly higher than those in secondary TE and normal controls. This suggests the role of the MCs in the pathogenesis of Primary Eosinophilic Colitis.
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Affiliation(s)
- Heyam Awad
- Histopathology, Microbiology and Forensic Medicine Department, University of Jordan, Amman, Jordan
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12
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Ornelas Saraiva R, Canha MI, Almeida V, Fernandes J, Dias A, Rodrigues AC, Carvalho D, Maltez F, Panarra A, Coimbra J. Gastrointestinal Symptoms and Liver Injury on Admission in a Hospitalised Population with COVID-19 Infection. ACTA MEDICA PORT 2021; 34:640-641. [PMID: 34863326 DOI: 10.20344/amp.16247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/22/2021] [Indexed: 11/20/2022]
Affiliation(s)
- Rita Ornelas Saraiva
- Gastroenterology Department. Centro Hospitalar Universitário de Lisboa Central. Lisboa. Portugal
| | - Maria Inês Canha
- Gastroenterology Department. Centro Hospitalar Universitário de Lisboa Central. Lisboa. Portugal
| | - Vasco Almeida
- Infectious Diseases Department. Centro Hospitalar Universitário de Lisboa Central. Lisboa. Portugal
| | - Jorge Fernandes
- Internal Medicine Department. Centro Hospitalar Universitário de Lisboa Central. Lisboa. Portugal
| | - André Dias
- Infectious Diseases Department. Centro Hospitalar Universitário de Lisboa Central. Lisboa. Portugal
| | - Ana Catarina Rodrigues
- Internal Medicine Department. Centro Hospitalar Universitário de Lisboa Central. Lisboa. Portugal
| | - Diana Carvalho
- Gastroenterology Department. Centro Hospitalar Universitário de Lisboa Central. Lisboa. Portugal
| | - Fernando Maltez
- Infectious Diseases Department. Centro Hospitalar Universitário de Lisboa Central. Lisboa. Portugal
| | - António Panarra
- Internal Medicine Department. Centro Hospitalar Universitário de Lisboa Central. Lisboa. Portugal
| | - João Coimbra
- Gastroenterology Department. Centro Hospitalar Universitário de Lisboa Central. Lisboa. Portugal
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Batebi S, Masjedi Arani A, Jafari M, Sadeghi A, Saberi Isfeedvajani M, Davazdah Emami MH. Validity and Reliability of the Persian Version of Leeds Dyspepsia Questionnaire. Galen Med J 2019; 8:e1609. [PMID: 34466536 PMCID: PMC8343703 DOI: 10.31661/gmj.v8i0.1609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 09/19/2019] [Accepted: 10/01/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND It is essential in clinical care services to measure the symptoms of functional dyspepsia both in the primary examination and treatment outcomes. No valid assessment tool is already available for functional dyspepsia in Iran. The present study aimed at evaluating the reliability, validity, and responsiveness of the Leeds dyspepsia questionnaire (LDQ). MATERIALS AND METHODS The LDQ was completed by 67 subjects with no dyspepsia symptoms and 93 subjects with certain functional dyspepsia diagnosed via endoscopy by a gastroenterologist and other clinical assessments. After definite diagnosis of functional dyspepsia, the participants were assessed by the LDQ. The psychometric characteristics of the questionnaire were then documented to investigate its reliability, validity, and responsiveness. RESULTS The internal consistency of the LDQ ranged from 0.80 to 0.89 and its test-retest reproducibility was 0.96. The LDQ was significantly correlated with all domains of dyspepsia symptom severity index (DSSI) and also with some of the domains of gastrointestinal symptom rating scale (GSRS). The LDQ had a sensitivity of 90.3% with a great specificity and a very good predictive validity. Moreover, a significant responsiveness to changes was observed (P<0.05). CONCLUSION The LDQ is a valid, reliable, reproducible, and self-rated instrument responsive to change, which can be used to measure the frequency and severity of functional dyspepsia symptoms in clinical trials.
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Affiliation(s)
- Sepideh Batebi
- Department of Clinical Psychology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbas Masjedi Arani
- Department of Clinical Psychology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Correspondence to: Abbas Masjedi Arani, Department of Clinical Psychology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Telephone Number: +9823031548 Email Address:
| | - Mahdi Jafari
- Department of Clinical Psychology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Sadeghi
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Saberi Isfeedvajani
- Medicine, Quran and Hadith Research Center & Department of Community Medicine, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran
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14
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Gonzalez T, Malagon C, Guarnizo P, Mosquera AC, Chila-Moreno L, Romero-Sanchez C. Autoantibodies and Gastrointestinal Symptoms in Colombian Children with Juvenile Idiopathic Arthritis. Curr Rheumatol Rev 2018; 14:163-171. [PMID: 29308742 DOI: 10.2174/1573397114666180108110429] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 08/25/2017] [Accepted: 12/15/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Juvenile Idiopathic Arthritis (JIA) is the most common inflammatory joint disease in children. JIA and autoimmune inflammatory Gastrointestinal (GI) diseases share common etiologic mechanisms, including genetic predisposition and environmental influences. OBJECTIVE To Investigate association between gastrointestinal, rheumatologic clinical variables and the presence of autoantibodies in patients with JIA in treatment. METHODOLOGY In a cross-sectional study of patients with JIA according to diagnostic criteria and the ILAR classification. GI symptoms and autoantibody expression were evaluated with respect to their association with JIA clinical variables. Anti-Saccharomyces Cerevisiae IgG/IgA (ASCA), 6 antigen associated with anti polymorphonuclear neutrophil (ANCA), anti Transglutaminase (tTG) IgG/IgA, anti deaminated gliadin peptide (DGP) IgG/IgA autoantibodies, ANAS and IgA were measured in all patients. The association between clinical variables and auto-antibodies were evaluated using the Fisher test with significant value of p <0.05. The study was approved by the ethics committee of the all institutions. RESULTS Samples were collected from ninety-seven patients, 63% of whom were female. The average age was 14 years. The JIA subtype associated with the most common GI symptoms was enthesitis- related arthritis. Of these patients, 44.3% and 14% reported abdominal pain and diarrhea, respectively. Anti-DPG and anti-tTG antibodies were found in 9.28% and 7.22%, respectively and 11.34% were positive for p-ANCA, and 2% were positive for ASCA. CONCLUSION GI symptoms and autoantibodies associated with inflammation of the GI mucosa were detected in JIA patients but were not associated with autoantibodies or clinical variables. However, it is the monitoring of these patients diagnosis is important.
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Affiliation(s)
- Tatiana Gonzalez
- Postgraduate Pediatric Rheumatology, School of Medicine, Universidad El Bosque, Bogota, Colombia
| | - Clara Malagon
- Postgraduate Pediatric Rheumatology, School of Medicine, Universidad El Bosque, Bogota, Colombia.,Pediatric Rheumatology Department, Hospital Militar Central, Bogota, Colombia.,Pediatric Rheumatology Department, Hospital Simon Bolivar, Bogota, Colombia.,Reumaped IPS, Bogota, Colombia
| | - Pilar Guarnizo
- Postgraduate Pediatric Rheumatology, School of Medicine, Universidad El Bosque, Bogota, Colombia.,Pediatric Rheumatology Department, Fundación Cardioinfantil, Bogota, Colombia
| | - Angela C Mosquera
- Postgraduate Pediatric Rheumatology, School of Medicine, Universidad El Bosque, Bogota, Colombia.,Pediatric Rheumatology Department, Clínica Infantil - Colsubsidio, Bogota, Colombia
| | - Lorena Chila-Moreno
- UIBO Institute-Oral Basic Research Unit, Universidad El Bosque, Bogota, Colombia
| | - Consuelo Romero-Sanchez
- Postgraduate Pediatric Rheumatology, School of Medicine, Universidad El Bosque, Bogota, Colombia.,Rheumatology and Immunology Department, Hospital Militar Central, Bogota, Colombia.,UIBO Institute-Oral Basic Research Unit, Universidad El Bosque, Bogota, Colombia
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Komarnicka J, Brzewski M, Banaszkiewicz A, Maciąg R, Krysiak R. Computed Tomography (CT) Angiography in Pre-Embolization Assessment of Location of Gastrointestinal Bleeding in Paediatric Patient with Granulomatosis with Polyangiitis (Wegener's Granulomatosis) - Case Report. Pol J Radiol 2017; 82:589-592. [PMID: 29662590 PMCID: PMC5894021 DOI: 10.12659/pjr.901282] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Accepted: 12/21/2016] [Indexed: 11/09/2022] Open
Abstract
Background Acute gastrointestinal bleeding is an emergency with a high morbidity and mortality. Early diagnosis and appropriate intervention can be lifesaving and can prevent long-term complications. Case Report In this case report, we discuss and illustrate the role of CT angiography in the evaluation of acute, active gastrointestinal haemorrhage and show its usefulness prior to embolization. We describe a 15-year-old girl with granulomatosis with polyangiitis, formerly known as Wegener's granulomatosis. Conclusions An accurate pre-embolization assessment of bleeding with CT angiography shortens the total diagnostic time, which results in prompt and more effective endovascular treatment.We describe the clinical presentation of our patient and present diagnostic and interventional radiologic findings.
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Affiliation(s)
- Justyna Komarnicka
- Department of Paediatric Radiology, Medical University of Warsaw, Warsaw, Poland
| | - Michał Brzewski
- Department of Paediatric Radiology, Medical University of Warsaw, Warsaw, Poland
| | - Aleksandra Banaszkiewicz
- Department of Paediatric Gastroenterology and Nutrition, Medical University of Warsaw, Warsaw, Poland
| | - Rafał Maciąg
- 2 Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland
| | - Remigiusz Krysiak
- Department of Paediatric Radiology, Medical University of Warsaw, Warsaw, Poland
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16
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Mansour-Ghanaei F, Asasi M, Joukar F, Rafiei R, Mansour-Ghanaei A, Hajipour-Jafroudi E. Two center experience of capsule endoscopy in Iran: Report on 101 cases. F1000Res 2017; 6:1765. [PMID: 29511530 PMCID: PMC5814745 DOI: 10.12688/f1000research.11288.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/29/2018] [Indexed: 11/20/2022] Open
Abstract
Background: Capsule endoscopy (CE) is a minimally invasive method for the visual examination of the small intestine, which may be for the evaluation and follow-up of patients with Crohn's disease. It can also be used to look at mucosal inflammation. Methods: This cross sectional study was used to determine the diagnostic efficacy of the CE system by performing a cross-sectional study of cases from 2011-2014. This study involved a total of 101 Iranian patients who were referred to the gastrointestinal and liver diseases outpatient clinics in Guilan (northern Iran) and in Isfahan (central Iran) for complaints of gastrointestinal problems. For all patients, definitive diagnosis had failed with the use of other diagnostic tools and CE was performed. Descriptive analysis was used. The patient population was represented by men and women equally, and the mean age of the patients was 42.3 ± 17.2 years (range: 16-89 years). Results: The final diagnoses were: non-specific enteritis (30.6%), Crohn's disease (20.7%), ulcers caused by aspirin or non-steroidal anti-inflammatory drugs (8.9%), mucosal erosion (5.9%) and angioectasia (4.9%); nearly 10% of the patients had normal findings. Analysis of the distribution of chief presenting complaints with patients stratified by the final diagnosis of Crohn's disease showed that the most frequently presented chief complaint was abdominal pain 42.9% and the least frequently presented chief complaint was diarrhea (4.8%). Conclusions: Small bowel evaluation by CE was well tolerated and capable of diagnosing Crohn's disease and gastrointestinal bleeding in patients who failed other diagnostic tests.
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Affiliation(s)
- Fariborz Mansour-Ghanaei
- Gastrointestinal and Liver Diseases Research Center, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Morteza Asasi
- Caspian Digestive Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Farahnaz Joukar
- Caspian Digestive Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Rahmatollah Rafiei
- Department of Internal Medicine, School of Medicine, Islamic Azad University, Najafabad, Isfahan, Iran
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17
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Mansour-Ghanaei F, Asasi M, Joukar F, Rafiei R, Mansour-Ghanaei A, Hajipour-Jafroudi E. Two center experience of capsule endoscopy in Iran: Report on 101 cases. F1000Res 2017; 6:1765. [PMID: 29511530 PMCID: PMC5814745 DOI: 10.12688/f1000research.11288.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/21/2017] [Indexed: 02/05/2023] Open
Abstract
Background: Capsule endoscopy (CE) is a minimally invasive method for the visual examination of the small intestine, which may be for the evaluation and follow-up of patients with Crohn's disease. It can also be used to look at mucosal inflammation. Methods: This cross sectional study was used to determine the diagnostic efficacy of the CE system by performing a cross-sectional study of cases from 2011-2014. This study involved a total of 101 Iranian patients who were referred to the gastrointestinal and liver diseases outpatient clinics in Guilan (northern Iran) and in Isfahan (central Iran) for complaints of gastrointestinal problems. For all patients, definitive diagnosis had failed with the use of other diagnostic tools and CE was performed. Descriptive analysis was used. The patient population was represented by men and women equally, and the mean age of the patients was 42.3 ± 17.2 years (range: 16-89 years). Results: The final diagnoses were: non-specific enteritis (30.6%), Crohn's disease (20.7%), ulcers caused by aspirin or non-steroidal anti-inflammatory drugs (8.9%), mucosal erosion (5.9%) and angioectasia (4.9%); nearly 10% of the patients had normal findings. Analysis of the distribution of chief presenting complaints with patients stratified by the final diagnosis of Crohn's disease showed that the most frequently presented chief complaint was abdominal pain 42.9% and the least frequently presented chief complaint was diarrhea (4.8%). Conclusions: Small bowel evaluation by CE was well tolerated and capable of diagnosing Crohn's disease and gastrointestinal bleeding in patients who failed other diagnostic tests.
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Affiliation(s)
- Fariborz Mansour-Ghanaei
- Gastrointestinal and Liver Diseases Research Center, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Morteza Asasi
- Caspian Digestive Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Farahnaz Joukar
- Caspian Digestive Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Rahmatollah Rafiei
- Department of Internal Medicine, School of Medicine, Islamic Azad University, Najafabad, Isfahan, Iran
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18
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Ahn SH, Um YJ, Kim YJ, Kim HJ, Oh SW, Lee CM, Kwon H, Joh HK. Association between Physical Activity Levels and Physical Symptoms or Illness among University Students in Korea. Korean J Fam Med 2016; 37:279-86. [PMID: 27688861 PMCID: PMC5039119 DOI: 10.4082/kjfm.2016.37.5.279] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 09/07/2015] [Accepted: 10/07/2015] [Indexed: 11/06/2022] Open
Abstract
Background Low levels of physical activity can cause various physical symptoms or illness. However, few studies on this association have been conducted in young adults. The aim of this study was to investigate the association between physical activity levels and physical symptoms or illness in young adults. Methods Subjects were university students who participated in a web-based self-administered questionnaire in a university in Seoul in 2013. We obtained information on physical activities and physical symptoms or illness in the past year. Independent variables were defined as symptoms or illness which were associated with decreased academic performance. Logistic regression was performed to calculate odds ratios (ORs) and 95% confidence intervals (CIs) of each physical symptom or illness with adjustment for covariables. Results A total of 2,201 participants were included in the study. The main physical symptoms or illness among participants were severe fatigue (64.2%), muscle or joint pain (46.3%), gastrointestinal problems (43.1%), headache or dizziness (38.6%), frequent colds (35.1%), and sleep problems (33.3%). Low physical activity levels were significantly associated with high ORs of physical symptoms or illness. Multivariable-adjusted ORs (95% CIs) in the lowest vs. highest tertile of physical activity were 1.45 (1.14–1.83) for severe fatigue, 1.35 (1.07–1.70) for frequent colds, and 1.29 (1.02–1.63) for headaches or dizziness. We also found that lower levels of physical activity were associated with more physical symptoms or bouts of illness. Conclusion Low physical activity levels were significantly associated with various physical symptoms or illness among university students. Also, individuals in the lower levels of physical activity were more likely to experience more physical symptoms or bouts of illness than those in the highest tertile of physical activity.
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Affiliation(s)
- Sang-Hyun Ahn
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yoo-Jin Um
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
| | - Young-Ju Kim
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyun-Joo Kim
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seung-Won Oh
- Department of Family Medicine, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Cheol Min Lee
- Department of Family Medicine, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Hyuktae Kwon
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hee-Kyung Joh
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea.; Department of Medicine, Seoul National University College of Medicine, Seoul, Korea.; Department of Family Medicine, Seoul National University Health Service Center, Seoul, Korea
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Martin JY, Urban RR, Liao JB, Goff BA. Bevacizumab toxicity in heavily pretreated recurrent epithelial ovarian, fallopian tube, and primary peritoneal cancers. J Gynecol Oncol 2016; 27:e47. [PMID: 27329195 PMCID: PMC4944014 DOI: 10.3802/jgo.2016.27.e47] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Revised: 03/31/2016] [Accepted: 05/02/2016] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Bevacizumab was recently approved by the US Food and Drug Administration for use in recurrent platinum resistant epithelial ovarian cancer (EOC), fallopian tube cancer (FTC), or primary peritoneal cancer (PPC) when no more than two prior cytotoxic regimens have been used; due to concerns for gastrointestinal perforation. We sought to determine bevacizumab-related toxicities in heavily pretreated recurrent EOC. METHODS We performed a retrospective chart review of patients with recurrent EOC, FTC, and PPC from 2001 to 2011. Patients who received at least two prior chemotherapy regimens before bevacizumab were included. Medical records were reviewed for bevacizumab associated toxicities. The Wilcoxon-Mann-Whitney test was used to compare quantitative variables. Survival was estimated with the Kaplan-Meier method. RESULTS Sixty patients met inclusion criteria. At the start of bevacizumab treatment, the median age was 60 years and the median body mass index was 26.5 kg/m². More than 50% of patients received bevacizumab after three prior cytotoxic regimens. Grade 3 or higher bevacizumab associated toxicity events occurred in four patients, including one patient who developed a rectovaginal fistula. The median overall survival from the start of bevacizumab treatment was 21.05 months (95% CI, 18.23 to 32.67; range, 1.9 to 110 months). The number of cytotoxic regimens prior to bevacizumab treatment did not differ in those that experienced a toxicity versus those that did not (p=0.66). CONCLUSION The use of bevacizumab in heavily pretreated EOC, FTC, or PPC is worth consideration.
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Affiliation(s)
- Jovana Y Martin
- Division of Gynecologic Oncology, University of Washington Medical Center, Seattle, WA, USA.
| | - Renata R Urban
- Division of Gynecologic Oncology, University of Washington Medical Center, Seattle, WA, USA
| | - John B Liao
- Division of Gynecologic Oncology, University of Washington Medical Center, Seattle, WA, USA
| | - Barbara A Goff
- Division of Gynecologic Oncology, University of Washington Medical Center, Seattle, WA, USA
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Eusébio M, Caldeira P, Antunes AG, Ramos A, Velasco F, Cadillá J, Guerreiro H. Olmesartan-Induced Enteropathy: An Unusual Cause of Villous Atrophy. GE Port J Gastroenterol 2016; 23:91-95. [PMID: 28868439 PMCID: PMC5579990 DOI: 10.1016/j.jpge.2015.09.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 09/14/2015] [Indexed: 12/20/2022]
Abstract
We report a case of a 63-year-old-man presenting with chronic diarrhea and weight loss while on olmesartan treatment for hypertension. Investigation showed multiple nutritional deficiencies associated with diffuse intestinal villous atrophy. Serologies for celiac disease were negative and other causes of villous atrophy were excluded. Olmesartan as a precipitant agent was suspected and withdrawn. Clinical improvement occurred in days with no need for other therapeutic measures. Follow-up at three months showed clinical remission and almost complete recovery of intestinal atrophy. Olmesartan is an angiotensin receptor blocker commonly prescribed for the management of hypertension. Spruelike enteropathy associated with this drug is a recently described entity with few cases reported. It presents with chronic diarrhea and intestinal villous atrophy and should be included in its differential diagnosis. This case intends to alert clinicians for the possibility of this event in a patient on treatment with this drug.
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Affiliation(s)
- Marta Eusébio
- Gastroenterology Departament, Centro Hospitalar do Algarve, EPE, Faro, Portugal
| | - Paulo Caldeira
- Gastroenterology Departament, Centro Hospitalar do Algarve, EPE, Faro, Portugal
| | - Artur Gião Antunes
- Gastroenterology Departament, Centro Hospitalar do Algarve, EPE, Faro, Portugal
| | - André Ramos
- Gastroenterology Departament, Centro Hospitalar do Algarve, EPE, Faro, Portugal
| | - Francisco Velasco
- Gastroenterology Departament, Centro Hospitalar do Algarve, EPE, Faro, Portugal
| | - Jesús Cadillá
- Pathology Department, Centro Hospitalar do Algarve, EPE, Faro, Portugal
| | - Horácio Guerreiro
- Gastroenterology Departament, Centro Hospitalar do Algarve, EPE, Faro, Portugal
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Ebrahimi M, Allahyari A, Ebrahimi M, Hesam H, Hosseini G, Karimi M, Rezaiean A, Kazemi MR. Effects of Dietary Honey andArdehCombination on Chemotherapy- Induced Gastrointestinal and Infectious Complications in Patients with Acute Myeloid Leukemia: A Double-Blind Randomized Clinical Trial. Iran J Pharm Res 2016; 15:661-8. [PMID: 27642340 PMCID: PMC5018297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We aimed to investigate the effects of dietary combination of honey and Ardeh on chemotherapy-induced complications in patients with acute myeloid leukemia (AML). A total of 107 AML patients who underwent chemotherapy for at least 30 consecutive dayswere recruited to this double-blind randomized placebo-controlled clinical-trial which was conducted in the Imam Reza and Ghaem teaching hospitals (Mashhad, Iran). They weredivided into two age and sex-matched groups: 58 treated and 49 untreated patients. A combination of 50 grams of honey and 150 grams of Ardehwas added to the treated group's diet for 30consecutive days, three times each day; while the untreated group received their regular diet.Both groups received their standard medication for AML as well. After one month, they were all examined and lab tests were done on them by an internist and laboratory technicians who were blinded to the subject allocations. Mean value of WBC count in treated group was significantly lower than that of untreated group. Duration of fever and admission in the hospital due to fever were both significantly lower in the treated group (P=0.014, P=0.032 respectively). Total gastrointestinal complications were significantly less in the treated group one month after therapy with the special honey and Ardeh compound.No unusual or unexpected side effects were observed. Honey and Ardehare easily accessible materials that can be helpfully administered in AML patientsreceiving chemotherapy, since their useful effects in ameliorating gastrointestinal complications and reducingfever and neutropenia in AML patients have been shown.
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Affiliation(s)
- Mahmoud Ebrahimi
- Cardiovascular Research Center, Imam Reza Teaching Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Abolghasem Allahyari
- Department of Hematology, Imam Reza Teaching Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Mohsen Ebrahimi
- Department of Emergency Medicine, Imam Reza Teaching Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Hesam Hesam
- Biochemistry of Nutrition Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Golkoo Hosseini
- Biochemistry of Nutrition Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | | | - Amin Rezaiean
- Mashhad University of Medical Sciences, Mashhad, Iran.
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Silva BMD, Neves SJ, Martínez AG, de Jesús Geneux K, García JL, Antolín SM, Millán AP. Enteropathy Associated with Olmesartan. GE Port J Gastroenterol 2015; 23:96-100. [PMID: 28868440 PMCID: PMC5580140 DOI: 10.1016/j.jpge.2015.10.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 10/25/2015] [Indexed: 11/17/2022]
Abstract
The recognition of an enteropathy caused by olmesartan is recent. It was first described in 2012 by the Mayo Clinic, which presented 22 clinical cases. Olmesartan is a highly prescribed drug and the differential diagnosis of a sprue-like enteropathy is very wide, so it is important to be aware of this pathology. We report a case of a 67-years-old man, with arterial hypertension under treatment with olmesartan, with a 4-months history of diarrhea and weight lost. He was admitted three times in our Department during this period of time. An initial diagnosis was made of lymphocytic colitis but he did not respond to treatment with corticosteroids. There was a high suspicion of celiac disease, so the patient started a gluten-free diet but still there were no symptomatic changes. The patient underwent several blood and imaging tests which were negative. Due to the suspicion of an enteropathy caused by drugs, olmesartan was stopped and the patient showed a significant improvement of his symptoms. The exact pathophysiology of this entity remains to be elucidated. It may affect all gastrointestinal tract and mimic a refractory celiac disease as well as a lymphocytic colitis due to similar symptoms and histology. It is expected more cases like this in the future due to high use of olmesartan in current clinical practice. So, it is important to all gastroenterologists to be aware of this pathology and take it into consideration when putting together a differential diagnosis.
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Affiliation(s)
| | - Sofia Jardim Neves
- General Surgery Department, Centro Hospitalar Cova da Beira, Covilhã, Portugal
| | | | | | - Jesús Lomas García
- Anatomical Pathology Department, Complejo Asistencial Universitario, Palencia, Spain
| | | | - Antonio Pérez Millán
- Gastroenterology Department, Complejo Asistencial Universitario, Palencia, Spain
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Sepanlou SG, Malekzadeh F, Naghavi M, Forouzanfar MH, Shahraz S, Moradi-Lakeh M, Malekzadeh R, Poustchi H. Trend of Gastrointestinal and Liver Diseases in Iran: Results of the Global Burden of Disease Study, 2010. Middle East J Dig Dis 2015; 7:121-37. [PMID: 26396715 PMCID: PMC4560627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 06/10/2015] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The general pattern of epidemiologic transition from communicable to noncommunicable diseases is also observed for gastrointestinal and liver diseases (GILD), which constitute a heterogeneous array of causes of death and disability. We aimed to describe the trend of GILD in Iran based on the global burden of disease (GBD2010) study from 1990 to 2010. METHODS The trend of number of deaths, disability, adjusted life years (DALYs) and their age-standardized rates caused by 5 major GILD have been reported. The change in the rankings of major causes of death and DALY has been described as well. RESULTS The age standardized rates of death and DALYs in both sexes have decreased from 1990 to 2010 for most GILD. The most prominent decreases in death rates are observed for diarrheal diseases, gastritis and duodenitis, and peptic ulcer disease. Positive trends are observed for liver cancer, pancreatic cancer, and gall bladder cancer. Diarrheal diseases have retained their 1st rank among children under 5. Among adults, decreased ranks are observed for diarrheal diseases, appendicitis, gastritis and duodenitis, gall bladder diseases, pancreatitis, and all types of cirrhosis. The trends in age standardized rates of DALYs, deaths, and YLLs are negative for almost all GILD, and especially for diarrheal diseases. However, there is no upward or downward trend in rates of years lost due to disability (YLDs) for most diseases. Total numbers of DALYs and deaths due to acute hepatitis C, stomach cancer, and liver cancers are rising. The total DALYs due to overall digestive diseases except cirrhosis and DALYs due to cirrhosis are both somehow stable. No data has been reported for GILD that are mainly diagnosed in outpatient settings, including gastroesophageal reflux disease, irritable bowel syndrome, and non-alcoholic fatty liver disease. CONCLUSION The results of GBD 2010 demonstrate that the rates of most GILD are decreasing in Iran but total DALYs are somehow stable. However, as diseases detected in outpatient settings have not been captured, the burden of GILD seems to be underestimated. Population-based studies at national level are required for accurate reports.
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Affiliation(s)
- Sadaf Ghajarieh Sepanlou
- 1 Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
,2Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran university of Medical Sciences, Tehran, Iran
, These two authors contributed equally to this paper
| | - Fatemeh Malekzadeh
- 1 Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
,3Non-Communicable Disease Research Center, Endocrine and Metabolism Research Institute, Shariati Hospital, Tehran University of medical Sciences, Tehran, Iran
, These two authors contributed equally to this paper
| | - Mohsen Naghavi
- 4Institute for Health Metric and Evolution, Seattle, WA, USA
| | | | - Saeid Shahraz
- 5Institute for Clinical Research and Health Policy Studies (ICRHPS ) Tufts Medical Center,USA
| | - Maziar Moradi-Lakeh
- 4Institute for Health Metric and Evolution, Seattle, WA, USA
,6Gastrointestinal and Liver Disease Research Center (GILDRC), Iran University of Medical Sciences, Tehran, Iran
| | - Reza Malekzadeh
- 1 Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
,2Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran university of Medical Sciences, Tehran, Iran
,7 Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Poustchi
- 1 Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
,2Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran university of Medical Sciences, Tehran, Iran
,7 Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
,Corresponding Author: Hossein Poustchi M.D/ Ph.D Digestive Diseases Research Center, Digestive Disease Research Institute, Shariati Hospital N. Kargar St. Tehran, Iran Tel: + 98 21 82415104 Fax:+ 98 21 82415400
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Abstract
OBJECTIVE The objective of this research was to gauge the diagnostic utility of serology tests compared with urea breaths tests (UBTs) and determine reliable threshold values/ranges for diagnosis of Helicobacter pylori infection using only immunoglobulin (Ig) G results. METHODS Data were obtained from 371 patients with UBTs and/or serology tests. Quantitative results were converted to multiple of minimum positive value (MMPV). Results were paralleled to obtain percentage change in serum IgG levels and 95% confidence intervals were obtained to establish new ranges for diagnosis. RESULTS Treated patients with only serology tests in a time frame of 3 to 6 months after final treatment displayed a 68.33% ± 2.95% decrease in 95% confidence interval of serum IgG. Uninfected patients with serology and UBT results within 2 weeks displayed a range of 1.32 ± 0.23 MMPV; infected patients produced a range of 3.32 ± 0.88 MMPV. CONCLUSION Treated patients should display a 65.38% to 71.28% decrease in serum IgG levels, along with an ending IgG level of ≤1.75 U/mL or ≤4.025 EV (ELISA value). Before treatment or exposure, patients with serum IgG values of 1.09 to 1.55 U/mL or 2.507 to 3.565 EV or lower are generally uninfected. Because of the lower cost and high confidence of results, we believe that IgG testing should be considered as a reasonable and even perhaps preferred method of monitoring H. pylori infections.
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Al-Maani AS, Paul G, Jardani A, Nayar M, Al-Lawati F, Al-Baluishi S, Hussain IB. Gastrointestinal Basidiobolomycosis: First case report from Oman and literature review. Sultan Qaboos Univ Med J 2014; 14:e241-e244. [PMID: 24790749 PMCID: PMC3997543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 11/26/2013] [Accepted: 01/05/2014] [Indexed: 06/03/2023] Open
Abstract
Gastrointestinal basidiobolomycosis (GIB) is a rare fungal infection with few reported cases worldwide. We report here the first case diagnosed in Oman in a previously healthy 5-year-old Omani female child who had been thought initially to have an abdominal malignancy. The case was referred to the Royal Hospital, Muscat, Oman, in July 2012. She was treated successfully with surgical resection and prolonged antifungal therapy (voriconazole). Physicians, including clinicians, radiologists and pathologists, should have a high index of suspicion for GIB when a patient presents with an abdominal mass and fever.
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Affiliation(s)
| | - George Paul
- Departments of Child Health, Royal Hospital, Muscat, Oman
| | | | | | | | | | - Ibrahim B. Hussain
- Department of Pediatrics, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
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