Pyocyanin preparation from Pseudomonas aeruginosa isolated from heterogeneous clinical materials

Pure pyocyanin was prepared from 120 strains of Pseudomonas aeruginosa isolated from different clinical specimens. The modified method used increased the purification 425-fold. The spectra of pyocyanin of all strains were found to be identical with a single major peak at 363 nm. The only difference between these spectra appeared to be the level value absorbance. Strains recovered from different clinical specimens differ in their ability for pigment production. The strains isolated from urine produced higher amounts of pyocyanin than other isolates.

Risk factors of stillbirth in Yemen

BACKGROUND

Yemen has the highest stillbirth rate among the Arab countries. However, the risk factors of this high rate are lacking. This study aimed to determine the maternal, newborn, and service related risk factors for stillbirths at the main maternity hospital in Sana'a city.

METHODS

A case-control study was conducted in the main maternity hospital in Sana'a city, Yemen. Case and controls were selected prospectively during the study period. Cases were women who delivered stillbirths after 24 weeks of gestation. Risk factors data for mothers and their neonates were collected using face-to-face interview and data abstraction from medical records.

RESULTS

The study included 101 women with stillbirths and 202 women with singleton live births. Mothers older than 35 years (Odds ratio (OR) = 4.9) and those with low level of education were significantly more likely to give stillbirths. Prolonged labor (OR = 5.8), mothers' anemia (OR = 2.1), less than 4 antenatal visits (OR = 5.1) and meconium stained amniotic fluid (OR = 11.5) were significantly associated with increased odds of stillbirth. Prematurity (OR = 27), umbilical complications (OR = 6.4), low birth weight (OR = 17.7), and congenital complications (OR = 40.6) were significantly associated with higher odds of stillbirths.

CONCLUSIONS

This study identified many risk factors of stillbirth that are amenable to intervention. Encouraging women to deliver at health facilities, providing better management of obstetrical complications, proper antenatal care, and prompt referral services are essential for reduction of stillbirths in Yemen.

Acute complicated diverticulitis is associated with an increased advanced neoplasia diagnosis rate: A retrospective study on 1852 patients

Recent reports have documented an unchanged rate of occurrence of colorectal cancer (CRC) and have publicised doubts regarding the benefit of prompt colonoscopy procedures after an episode of acute diverticulitis (AD). These reports mandate further evaluation of colonoscopy yield and timing in this regard. The current study aims to determine whether the rate of advanced colonic neoplasia after AD differs from that of average-risk patients, and to identify risk factors that are associated with their development.In this retrospective study, we included all patients who had been hospitalized to the surgery ward in the years 2008 to 2016 with radiographically confirmed AD, and had completed colonoscopies within one year of index hospitalization. Patients who were referred for screening colonoscopies during the same years were included as a control group. We compared the rates of diagnosis of CRC and advanced polyps for both groups before and after adjustment for multiple confounders. Moreover, we investigated risk factors that were associated with increased rate of advanced neoplasia diagnosis.A total of 350 patients were included in the AD group and 1502 patients in the screening colonoscopy control group. The CRC diagnosis rates (1.7% vs 0.3%; P = .09) and overall diagnosis rates of advanced neoplasia (12.3% vs 9.6%; P = .19) were not significantly different when findings were compared between the AD and control groups, respectively. Cases of complicated diverticulitis, however, were associated with increased risk of advanced neoplasia diagnosis (odds ratio (OR) 3.729, 95% confidence interval (CI) 1.803-7.713; P = .01).The diagnosis rate for advanced neoplasia after AD was not significantly different from that of average-risk populations. A course of complicated AD, however, was a potential risk factor.

Pulmonary embolism risk in hospitalized patients with nonalcoholic fatty liver disease: A case-control study

Abundant research has associated nonalcoholic fatty liver disease (NAFLD) with atherosclerosis, but very few reports have evaluated the association between NAFLD and venous thromboembolism. We aimed to investigate the association between NAFLD and pulmonary embolism (PE) in hospitalized patients. In this retrospective case-control study, we included consecutive patients from 2 university-affiliated hospitals who were referred for CT pulmonary angiograms for a suspected PE. Patients with a history of excessive alcohol consumption, chronic liver diseases or cirrhosis were excluded. The imaging studies of the entire cohort were reviewed by 2 expert radiologists who confirmed the diagnosis of PE and examined the liver to detect and grade hepatic steatosis. Accordingly, patients were categorized into NAFLD patients and non-NAFLD controls. Patient demographics, medical history, hospitalization details as well as patients' outcomes were documented. Multivariate analysis was performed to identify predictors for developing PE and hazard ratios with corresponding 95% confidence intervals were estimated. A total of 377 patients (101 with NAFLD and 276 controls) were included. NAFLD patients had significantly higher BMI values (33.16 ± 6.78 vs 26.81 ± 5.6; P < .001) and prevalence of diabetes (41 (40%) vs 85 (30.8%); P = .03). The prevalence of PE was significantly higher in the NAFLD group (80 (79.2%) vs 147 (53.3%), P < .001). In a multivariate analysis, older age, recent surgery or trauma, active malignancy, smoking, and NAFLD (HR ratio = 4.339, P < .0001 and 95% CI = 2.196-8.572) were independently associated with PE development. Patients with NAFLD were associated with an increased risk of developing PE independent of other classical risk factors for PE.

A rare case of adult colocolonic intussusception of the descending colon

A 28-year-old woman approached the emergency department because of recent diffuse abdominal pain and diarrhoea. Peritoneal signs on physical exam led to abdominal CT scan which demonstrated colonic obstruction, resulting from colocolonic intussusception of the descending colon. An exploratory laparotomy confirmed the diagnosis as well as the aetiology of a 4 cm intraluminal polyp. Left hemicolectomy with primary anastomosis was performed. The final pathology revealed a tubulovillous adenoma with multiple foci of high-grade dysplasia. Intussusception is a rare cause for colonic obstruction, and ~90% of cases in adults are secondary to an anatomical or pathological condition. Therefore, we recommend oncological resection of the affected part.

Chronic hepatitis B infection and diabetes mellitus: a double liver trouble?

BACKGROUND

Concomitant Diabetes mellitus (DM) is commonly recognized in patients with chronic hepatitis B (CHB) infection, although its impact on liver-related outcomes remains controversial. We aimed to evaluate the effect of DM on the course, management and outcome of patients with CHB.

METHODS

We performed a large retrospective cohort study utilizing the Leumit-Health-Service (LHS) database. We reviewed electronic reports of 692106 LHS members from different ethnicities and districts in Israel from 2000-2019 and included patients with CHB diagnosis based on ICD-9-CM codes and supportive serology results. These were divided into two cohorts of patients with CHB and DM (CHD-DM) (N.=252) and those with CHB without DM (N.=964). Clinical parameters, treatment figures and patients' outcomes were compared and multiple regression models and Cox regression analysis were performed to investigate the association between DM and cirrhosis/HCC risk in CHB patients.

RESULTS

CHD-DM patients were significantly older (49.2±10.9 vs. 37.9±14, P<0.001), and had higher rates of obesity (BMI>30) and NAFLD (47.2% vs. 23.1%, and 27% vs. 12.6%, P<0.001, respectively). Both groups had a predominance of inactive carrier (HBeAg negative infection) state, but the HBeAg seroconversion rate was significantly lower in the CHB-DM group (25% vs. 45.7%; P<0.01). Multivariable Cox regression analysis showed that DM was independently associated with increased cirrhosis risk (HR 2.63; P=0.002). Older age, advanced fibrosis and DM were associated with HCC, but DM did not reach significance (HR 1.4; P=0.12) possibly due to the small number of HCC cases.

CONCLUSIONS

Concomitant DM in CHB patients was significantly and independently associated with cirrhosis and possibly with increased risk of HCC.

Ethnic disparities in colorectal cancer outcomes a population study from Israel

Objectives: Colorectal cancer (CRC) is an important cause of morbidity and mortality worldwide. Clear ethnic disparities in the incidence of CRC and its outcomes have been observed globally, but only few research efforts have been invested so far in the unique ethnic scene of Israeli population. This study aims to compare the clinico-pathologic features, tumor's characteristics and prognosis between Arab and Jewish CRC patients as well as among Jewish subgroups living within the same central coastal region in Israel.Methods: In this retrospective, single center study, a total of 401 patients with pathologically confirmed CRCs diagnosed during the years 2008-2015 were included. These were divided into Jewish (n = 334) and Arab (n = 67) groups. Data collected included demographics, country of birth, clinical presentation and family history. Tumor stage, location, histologic grade and mortality rate were compared retrospectively between both groups and within Jewish sub-populations.Results: Arabs were significantly younger at diagnosis (62.7 ± 12.9 vs. 69.3 ± 13.01; P < 0.01), presented more frequently with rectal bleeding, and were less likely to be diagnosed due to positive fecal occult blood test (9% vs. 22.6%; P = 0.012). Tumor distribution through the colon was comparable between both groups and characterized by a distal predominance. Arabs had a significantly higher rate of advanced stage at diagnosis (58% vs. 50.5%, OR = 2.454, 95%CI = 1.201-5.013; P = 0.02) when compared to Jews. Mortality rates were comparable between both groups. In the Jewish subpopulation analysis, we found that immigrants, especially those born in the former USSR, presented with significantly advanced tumor stages when compared to native Israelis (55% vs. 37.5%; P = 0.02).Conclusion: CRC in two major ethnic populations in Israel, Arabs and Jews, varied in terms of age at diagnosis, clinical presentation and stage at diagnosis. Similar findings were documented within a non-native Jewish subpopulation, raising the possibility of a low utilization of screening programs in these groups.

A Large Comparative Cohort Study of Colonoscopy in the Elderly: Indications, Outcomes, and Technical Aspects

Introduction  Performing colonoscopy in the elderly is associated with unique challenges, including higher rates of comorbidities, limited physiological reserve, and procedural complexities. This study aimed to evaluate the technical aspects, indications, and outcomes of colonoscopy in the elderly, with an emphasis on indication-based diagnostic yield. Methods  In this retrospective cohort study, we reviewed 35,000 consecutive colonoscopy procedures performed over a 12-year period on patients aged 50 years and older. Patients were categorized into three groups: very elderly (>80 years, n=3,434), elderly (65-80 years, n=13,783), and younger controls (50-64 years, n=17,959). Clinical and endoscopic findings were analyzed, with a focus on indication-specific outcomes. Results  The most frequent indications for colonoscopy in the very elderly and elderly groups were anemia and rectal bleeding. Both elderly groups exhibited higher rates of inpatient procedures (49.2% and 20.9% vs. 9.6%; P<0.0001), inadequate bowel preparation (18.5% and 13.5% vs. 9.1%; P<0.0001), and anesthesiologist involvement in sedation (6.0% and 3.9% vs. 2.1%; P=0.03) but required lower doses of propofol sedation (4.5% and 5.4% vs. 7.9%; P=0.026). Colorectal cancer (CRC), polyps, and diverticulosis detection increased linearly with age. Colonoscopies performed for anemia or rectal bleeding yielded higher CRC and polyp detection rates, whereas constipation was associated with the lowest diagnostic yield. Conclusion This study highlights the technical challenges associated with performing colonoscopy in elderly patients, identifies indications with the highest diagnostic yield, and underscores the necessity of tailored bowel preparation protocols and an indication-driven approach to optimize the clinical utility of colonoscopy in this population.

EXPRESS: Predictors for Significant Hepatic Fibrosis in Chronic HBV Patients in Daily Clinical Practice: A Prospective Study

Accurate knowledge of fibrosis levels is essential for effective treatment decisions and prognostication in chronic hepatitis B (CHB) infection. Current guidelines recommend liver biopsy and elastography as the most reliable methods for assessing fibrosis in CHB patients. However, these methods are not widely implemented due to the limited availability, high costs, and invasiveness of liver biopsy. Thus, we aimed to identify simple clinical predictors of significant liver fibrosis in CHB patients in daily practice. We prospectively recruited CHB patients to undergo shear wave elastography (SWE), abdominal ultrasound, and blood tests. In parallel, we extracted data on patient demographics, habits, medical backgrounds, medications, and CHB status and treatment. Multivariate logistic regression analyses were used to determine predictors of significant fibrosis. Of the 173 patients included in the final analysis, 40 (23.0%) had evidence of significant fibrosis on two-dimensional SWE. Age> 50 years [odds ratio (OR): 3.53; 95% confidence interval (CI): 1.34-9.25; P= 0.001], alanine aminotransferase > 40 (OR: 8.16; 95%CI: 4.6-15.3; P= 0.001), hepatitis B virus DNA> 2000 (OR: 9.20; 95%CI: 3.4-19.0; P< 0.001), concomitant diabetes mellitus (OR: 3.58; 95%CI: 1.89-5.49; P= 0.040), moderate to severe steatosis on ultrasound (OR: 4.50; 95%CI: 2.35-9.95; P= 0.014), and heavy smoking were independent predictors of significant fibrosis. In conclusion, we identified clinical and laboratory variables that may effectively identify CHB patients at high risk of significant fibrosis. These can aid in resource allocation in daily practice with limited resources.

The Yield of Colonoscopy in the Evaluation of Constipation: An Age-Based Analysis of Outcome

Background: Chronic constipation, a prevalent gastrointestinal complaint, exhibits rising incidence and diverse clinical implications, especially among the aging population. This study aims to assess colonoscopy performance in chronic constipation across age groups, comprehensively evaluating diagnostic yield and comparing results with average-risk controls. Methods: A retrospective analysis was conducted on 50,578 colonoscopy procedures performed over 12 years, including 5478 constipated patients. An average-risk control group (n = 4100) was included. Data extracted from electronic medical records covered demographics, operational aspects, and colonoscopy findings. The primary outcome measures included the diagnosis rate of colorectal cancer (CRC), polyp detection rate (PDR), and inflammatory bowel disease (IBD) diagnoses in constipated patients versus controls, with age-based and multivariate analyses. Results: Constipated patients exhibiting lower rates of adequate bowel preparation (92.7% vs. 85.3%; p < 0.001) and a lower cecal intubation rate. No significant variances between CRC and PDR were observed between constipated and controls, except for a potential of a slightly elevated CRC risk in constipated patients older than 80 (2.50% vs. 0% in controls; p = 0.07). Multivariate analysis demonstrated, across all age groups, that constipation did not confer an increased risk for CRC or polyp detection. Younger constipated patients exhibited a higher rate of IBD diagnoses (1.7% vs. 0.1% in controls; p < 0.001). Conclusions: Constipation did not confer an increased risk for CRC or polyps, among any age groups, except for a potential signal of elevated CRC risk in patients older than 80; additionally, it was associated with higher rates of IBD in younger patients.

5879Coronary microvascular dysfunction is associated with poor glycemic control in women with diabetes presenting with chest pain and non-obstructive coronary artery disease

Background

Patients with type 2 diabetes are at an increased risk of cardiovascular events compared to individuals without diabetes. The role glycemic control plays in reducing cardiovascular risk remains uncertain. Coronary microvascular dysfunction (CMD) is more frequent in women compared to men, is prevalent in patients with type 2 diabetes and is linked to adverse cardiovascular events. We compared the association between CMD and glycemic control across sexes in patients with chest pain and non-obstructive coronary artery disease (CAD).

Methods

Patients with chest pain who were found to have non-obstructive CAD (stenosis <40%) at angiography underwent an invasive assessment of endothelial-independent and endothelial–dependent coronary microvascular function. Using a Doppler guidewire, endothelial-independent microvascular function was assessed by measuring the coronary flow velocity in response to intracoronary adenosine and comparing this to baseline to calculate the coronary flow reserve ratio (CFRAdn). A CFRAdn ≤2.5 was considered abnormal. Endothelial-dependent microvascular function was assessed by measuring the percent change in coronary blood flow in response to intracoronary infusions of acetylcholine (%ΔCBFAch), with a %ΔCBFAch ≤50% considered abnormal. Patients were classified as having normal versus abnormal CFRAdn and %ΔCBFAch. Measurements of HbA1c and fasting serum glucose were obtained at the time of catheterization and compared between groups after stratification by sex.

Results

Between 1993 and 2012, 1,469 patients (mean age 50.4 years, 35% male) underwent coronary angiography and invasive testing for CMD, of which 129 (8.8%) had type 2 diabetes. Fifty one (39.5%) had an abnormal %ΔCBFAch and 49 (38.0%) had an abnormal CFRAdn. Conventional cardiovascular risk factors did not vary significantly between groups. Females with an abnormal CFRAdn or abnormal %ΔCBFAch had a significantly higher HbA1c compared to those with a normal CFRAdn or %ΔCBFAch respectively: HbA1c % (standard deviation) 7.4 (2.1) vs. 6.5 (1.1), p=0.035 and 7.3 (1.9) vs. 6.4 (1.2), p=0.022, respectively. Females with an abnormal CFRAdn had significantly higher fasting serum glucose concentrations compared to those with a normal CFRAdn: fasting serum glucose mg/dL (standard deviation) 144.4 (55.6) vs. 121.9 (28.1), p=0.035. These effects were not observed in men. Amongst female diabetics, a higher HbA1c was significantly associated with any CMD after adjusting for covariates: odds ratio (95% confidence interval) 1.69 (1.01 – 2.86) p=0.049; and a fasting serum glucose >140 mg/dL was significantly associated with an abnormal CFRAdn, 4.28 (1.43–12.81).

Conclusion

Poor glycemic control is associated with CMD in females with diabete who present with chest pain and non-obstructive CAD. These findings highlight the importance of sex-specific risk stratification models and treatment strategies when managing cardiovascular risk in diabetics.

Acknowledgement/Funding

Mayo Foundation

Characterizing Unique Clinical and Virological Profiles in Concurrent Chronic Hepatitis B and Metabolic Dysfunction-Associated Liver Disease: Insights from a Population-Based Cohort Study

Background: The concurrent presence of chronic hepatitis B virus (CHB) infection and metabolic dysfunction-associated steatotic liver disease (MASLD) presents a unique clinical scenario with implications that are not yet fully understood. This study aims to characterize the distinct clinical and virological features of CHB in the context of MASLD and evaluate its impact on disease progression and outcomes. Methods: Utilizing a comprehensive health maintenance organization database, this study included 1186 patients with CHB from 2000-2020. Patients were categorized into two groups: CHB-MASLD (n = 188) and CHB alone (n = 998). CHB diagnosis was confirmed by serological markers, while MASLD was diagnosed based on imaging and cardiometabolic risk factors. Comparative analysis and multiple regression models were applied to assess variables related to viral parameters and clinical outcomes. Results: The CHB-MASLD group was older (mean age of 45.2 vs. 39.1, p < 0.001) with higher rates of obesity (46.8% vs. 23.8%, p < 0.001), diabetes (36.2% vs. 17.3%, p < 0.001), and dyslipidemia. Distinct viral profiles included higher HBeAg negativity (96.2%), a higher rate of HBeAg-negative infection (70.4% vs. 63.8%; p < 0.001), and increased HBeAg seroconversion under treatment. Cirrhosis was more prevalent in the CHB-MASLD group (9.6% vs. 4.4%, p = 0.007), while HCC rates were comparable. Multivariate analysis identified age, male gender, chronic active hepatitis, and diabetes as predictors of cirrhosis. Conclusions: CHB-MASLD patients were distinguished by a higher prevalence of metabolic features, along with a distinct viral profile marked by increased chronic HBeAg infection, higher rates of HBeAg seroconversion, and a potential association with worse disease outcomes.

Gastroscopy Yield in the Young: Comprehensive Assessment of Endoscopic and Histologic Findings—A Comparative Study

Background. The escalating utilization of gastroscopy in young individuals necessitates an in-depth examination of its diagnostic yield and outcomes in this population. This study aims to investigate and compare various aspects of gastroscopy between young and older adults, shedding light on age-related differences in indications, endoscopic findings, histologic outcomes, and clinically significant findings (CSFs). Methods. A retrospective, large cohort study spanning five years, focused on consecutive patients undergoing gastroscopy. We analyzed age subgroups, specifically categorizing patients into those aged 30 and below, 30–39, 40–49, and a control group aged 50 and above. The investigation aimed to compare various aspects of gastroscopy outcomes among these distinct age categories. Indication-based analyses were conducted to assess the yield and outcomes in these subgroups, focusing on CSFs and the number needed to investigate (NNTI). Results. A total of 1313 young patients aged 16–49 and 3396 controls aged 50 and above were included. Among the young patients, unspecified epigastric pain and dyspepsia emerged as a prevalent indication, accounting for 41.5% of cases. Endoscopic findings revealed a significantly higher diagnosis rate of gastritis than controls (48.2% vs. 35.7%; p<0.001). Histologic analysis demonstrated a substantially elevated rate of H. pylori-associated gastritis in the young (41.1% vs. 29%; p<0.001). Notably, although significantly lower than older controls, precancerous lesions were detected in 7.5% of young patients. CSFs’ diagnosis rate displayed a clear age-dependent increase. Particularly, gastroscopy for upper gastrointestinal bleeding and iron deficiency anemia were associated with higher CSF rates across all young-age subgroups. In multivariate analysis, age and indications of upper gastrointestinal bleeding and iron deficiency anemia were predictors of CSFs’ detection in young patients. Conclusion. This study comprehensively delineates various facets of gastroscopy in the young population, elucidating age and indication-specific patterns in endoscopic and histologic findings, and clinically significant outcomes.

The mechano-biology of the epiphysis of the long bones as revealed by photoelastic models

Stress contours have been generated in photoelastic models simulating cartilaginous and bony epiphyses. According to the findings, the secondary centre of ossification is formed in areas of the cartilaginous epiphysis shown to have reduced mechanical stress. The bony epiphysis appears to have been developed as a more mechanically efficient structure.

Hepatitis B virus infection and risk of colorectal cancer: a large, population-based cohort study from Israel

BACKGROUND

Recent population-based studies have suggested a possible link between hepatitis B (HBV) infection and extra-hepatic malignancies. We aimed to evaluate the association between HBV and colorectal cancer (CRC) using a large, population-based cohort study utilizing data from a large health maintenance organization (HMO).

METHODS

The study included patients with non-cirrhotic HBV based on relevant ICD-9-CM codes and supportive serology identified from the HMO's database. Age-, sex-, ethnicity-, and BMI-matched non-HBV patients in a 1:10 ratio were included in the control group. We assessed the overall diagnosis rate of CRC and hepatocellular carcinoma (HCC) during the study period and calculated the diagnosis rate of CRC in each age category (≤50, 51-70, and ≥70) in both groups.

RESULTS

A total of 3430 HBV patients and 34,300 controls were included in the study. The mean age, sex, BMI, and ethnic composition were similar, and the rates of family history of CRC did not differ between both groups. The overall follow-up period was 134±16 months. The diagnosis rate of HCC (1.6% vs. 0.1%; P<0.0001) was significantly higher in the HBV patients. However, the proportion of CRC was comparable for both groups (0.6% vs. 0.8%, P=0.404), which was evident in all age subgroups.

CONCLUSIONS

Our findings suggest that HBV infection is associated with an increased risk of HCC diagnosis but is not linked to an elevated risk of CRC. These findings may inform future clinical practice and research regarding the relationship between HBV and extrahepatic malignancies.

Clinical and endoscopic predictors of gastric precancerous conditions: a large population case control study

BACKGROUND

Atrophic gastritis (AG) and gastric intestinal metaplasia (GIM) are well defined intermediate precancerous conditions (PCCs) in the gastric cancer cascade. The diagnosis of PCCs may be suspected based on endoscopic findings but is established by histology. Estimates of the global prevalence of PCCs vary widely but simple clinical or endoscopic predictors of their diagnosis are ill defined. We aimed to evaluate the prevalence of gastric PCCs in our practice and to identify predictors for its diagnosis.

METHODS

We analyzed electronic reports of patients referred for gastroscopy procedures over a 5-year period and included those for whom gastric biopsies were performed. We investigated demographic, clinical, and endoscopic findings to identify possible association with histologic detection of gastric PCCs and performed multivariate analysis to identify predictors of its diagnosis.

RESULTS

A total of 4930 patients with full endoscopic and histologic data were included for the final analysis. Of these, 806 (16.3%) patients had a histologic diagnosis of gastric PCCs. Demographic and clinical variables including male sex (51.4% vs. 45.7%; P=0.003), age over 60 (69.8% vs. 45.2%; P<0.001), and anemia indication for gastroscopy (17.6% vs. 14.8%; P=0.04) were significantly associated with gastric PCCs diagnosis. Likewise, endoscopic findings of Barret's esophagus (2.6% vs. 1.3%; P=0.006), atrophic gastritis according to endoscopist's judgment (12.9% vs. 3.5%; P<0.01) and corpus predominant gastritis (22.5% vs. 14.7%; P=0.02) were significantly associated with gastric PCCs. In multivariate analysis, age>60 (please explain all acronyms HR 2.51, 95% CI 2.12-2.96), male sex (HR 1.235, 95% CI 1.05-1.44), corpus predominant (HR 1.284, 95% CI 1.04-1.57), and atrophic gastritis (HR 4, 95% CI 3.07-5.21) were independent predictors for PCCs diagnosis.

CONCLUSIONS

Not uncommonly encountered in our practice, a judicious performance of gastric biopsies to detect gastric PCCs should be adopted especially in older, male patients with endoscopic findings of corpus predominant and/or gastric atrophy.

Predictors of Clinical Course and Outcomes of Acute Diverticulitis: The Role of Age and Ethnicity

Background and Objectives: Acute diverticulitis (AD) is the leading and most burdensome complication of colonic diverticulosis. However, risk factors for its development and predictors of its course are still poorly defined. In this regard, the association of a young age with a complicated course and worse outcome are still controversial. Moreover, little research has addressed the effect of ethnicity on the course of AD. The current study aimed to evaluate the impact of these variables on AD’s course and outcome in the diverse and unique ethnic landscape of Israel. Materials and Methods: We performed a retrospective review of the charts of patients with a radiologically confirmed diagnosis of AD. Patients’ outcomes and disease course, including hospitalization duration, complications, and recurrent episodes, were documented and compared among different age and ethnic groups. Multivariate analysis was performed to identify predictors of complicated AD. Results: Overall, 637 patients with AD were included, the majority (95%) had distal colon AD, and almost one quarter of them were aged less than 50 years. The majority of patients in the young age (<50) group were males (69.7%). Nonetheless, the rate of recurrent episodes (35.3% vs. 37.3%, p = 0.19), hospitalization duration (5 ± 4.7 vs. 6 ± 3.2, p = 0.09) and complications rate (17.3% vs. 13.7%; p = 0.16) were similar for both age groups. In the ethnicity group analysis, Arab minority patients had a first episode of AD at a significantly younger age compared to their Jewish counterparts (51.8 vs. 59.4 years, p < 0.001). However, factors such as a complicated course (16% vs. 15%; p = 0.08) and relapsing episode rates (33% vs. 38%; p = 0.36) did not differ significantly between groups. None of the variables, including young age and ethnic group, were predictors of complicated AD course in the multivariate analysis. Conclusion: AD is increasingly encountered in young patients, especially in ethnic minority groups, but neither ethnicity nor young age was associated with worse outcomes.